Evaluation of the serum levels of hepcidin and comparison with fecal calprotectin values as a measure of disease activity in inflammatory bowel diseases

Crohn disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD). Anemia in IBD is mostly due to iron deficiency or anemia of chronic disease. Activity scales and some laboratory indicators are used to determine disease activity. Hepcidin, the main iron metabolism regulating protein, increases in response to inflammation and decreases in response to iron deficiency. In this study we aimed to reveal the correlation between serum hepcidin levels and fecal calprotectin values in determining disease activity and the usefulness of serum hepcidin levels in differential diagnosis of anemia. We included 74 patients who were on follow-up due to IBD at Başkent University Ankara Hospital in the year of 2014, of whom 29 were active and of whom 45 were in remission and 34 completely healthy individuals as control group. Complete blood count, serum hepcidin, ferritin, serum iron, total iron binding capacity (TIBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) were measured in both patient and control groups. Besides fecal calprotectin values were measured in patients. Crohn disease activity index was used for Crohn patients, Truelove-Witts activity score was used for ulcerative colitis patients. Serum hepcidin levels were significantly higher in active and remission group in comparison to control group (p=0.014 ve p=0.004). Hepcidin levels were similar in active and remission group (p=0.470). A negative correlation was found between hepcidin levels and transferrin saturation rates (r=-0.455 and p=0.013) though positive correlation was found between hepcidin and RDW in active group (r=0.513 and p=0.004). Mean fecal calprotectin was significantly higher in active group compared to remission group (p<0.001). A positive correlation was found between fecal calprotectin and clinical activity score, CRP, ESR (p<0.01). There was no correlation between hepcidin and fecal calprotectin (p>0.025). In patient group mean hepcidin was higher in anemic patients compared to non-anemic patients (p=0.093). We couldn't find significant correlation between hepcidin and disease activity and markers of iron deficiency in this study. Further randomized controlled studies are required to evaluate serum hepcidin levels with disease activity and for differential diagnosis of anemia in IBD.