N03 Iron deficiency anaemia as a risk factor for relapse or persistence of clinical activity in patients with Ulcerative Colitis.

Abstract Background It has been reported that the frequency of iron deficiency anaemia in patients with Ulcerative Colitis (UC) is 28.7%1. This is one of the most common extra-intestinal manifestations, reflecting chronic inflammatory states. The main objective for patients who debut with UC is to achieve remission, thereby reducing the intestinal and extra-intestinal complications associated with inflammation2. Aim: To determine the risk of clinical persistence or relapse associated with iron deficiency anaemia in patients with UC at 6 months after diagnosis. Methods A total of 371 patients diagnosed over 10 years were evaluated, of whom 158 had complete data for analysis. Baseline measures of clinical activity were obtained using the Mayo scale. Clinical relapse was defined as the change from remission to clinical activity at 6 months of follow-up, and clinical persistence was characterised by patients who never reached remission since their baseline visit. Laboratories were obtained at baseline, and anaemia was determined using the haemoglobin cut-off points established by the WHO: 12g/dL for women and 13g/dL for men. Odds ratios (OR) were calculated to determine the risk of clinical persistence or relapse at 6 months. Kruskal–Wallis was used to determine the differences between the remission, relapse, and persistence groups. Statistical significance was taken with p 0.05 Results A total of 158 patients with UC were included; their average age was 43 years, with 52% being men and 48% being women. The UC extension was 57% pancolitis, 11% left colitis, and 32% proctitis. 26% were in remission, 53% had relapsed, and 21% were persistent. In total, 59% of the patients had iron deficiency anaemia, of which 37 were relapsed, 14 were persistent, and eight were in remission. Serum iron levels were lower in all three groups, with ferritin levels also being low in all three groups, showing a decreasing trend in the remission group and a slight increase in the persistence group, although there were no statistically significant differences. Haemoglobin levels were higher in the remission group compared to the relapsed and persistent groups, which had lower haemoglobin levels (Table 1). An OR of 1.9 (95% CI, 1.1–3.2; p = 0.022) was found for clinical persistence, and an OR of 1.4 (95% CI, 1.1–1.9; p = 0.002) for clinical relapse at 6 months in patients with iron deficiency anaemia. Conclusion Iron deficiency anaemia was associated with worse clinical outcomes at 6 months of follow-up. Patients with anaemia have nearly twice the risk of experiencing clinical persistence and higher risk of relapse compared with those without anaemia (figure 1). This study suggests that the presence of anaemia at disease onset is an unfavorable independent marker of UC. References: 1. Eriksson C, Henriksson I, Brus O, et al. Incidence, prevalence and clinical outcome of anaemia in inflammatory bowel disease: a population-based cohort study. Aliment Pharmacol Ther. Sep 2018;48(6):638-645. doi:10.1111/apt.14920 2. Koutroubakis IE, Ramos-Rivers C, Regueiro M, et al. Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. Oct 2015;13(10):1760-6. doi:10.1016/j.cgh.2015.03.029 Conflict of interest: Mendoza Martinez, Viridiana Montsserrat: No conflict of interest Yamamoto-Furusho, Jesús Kazuo: No conflict of interest Baños Vazquez, Roberto: No conflict of interest Santoyo-Chávez, Martha Alison: No conflict of interest Rivera, Ernestina: No conflict of interest De Leon Rendon, Jorge Luis: No conflict of interest Bueno Hernández, Nallely: No conflict of interest