ArticleThe Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology2026
Red Cell Distribution Width as an Independent Marker of Objective Disease Activity in Ulcerative Colitis and Crohn's Disease: A Large Real-World Cohort of 1000 Patients.
Article in The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background/Aims: The treat-to-target (T2T) strategy requires objective biomarkers in inflammatory bowel disease (IBD). Red cell distribution width (RDW) is of interest and routinely available; however, its incremental diagnostic value beyond anemia and inflammatory markers for detecting endoscopic activity (and histologic activity in ulcerative colitis) remains unclear. Materials and Methods: This retrospective cohort included 1000 IBD patients (ulcerative colitis (UC) = 580, Crohn's disease (CD) = 420). Objective activity was defined endoscopically (UC: Mayo endoscopic subscore ≥2; CD: SES-CD ≥3), with histologic activity (Nancy Index ≥1) as a prespecified secondary endpoint in UC. Red cell distribution width was measured within a peri-endoscopic window (median 1 day; IQR 0-3). Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis, reporting observed and optimism-corrected area under the curve (AUC). Incremental value over C-reactive protein (CRP) was evaluated using the DeLong method. Multivariable logistic regression was adjusted for anemia, iron-related parameters, inflammatory markers, disease extent, and medications. Results: Active disease is present in 432 patients (43.2%). The RDW is higher in active vs. inactive disease (15.6 ± 1.8% vs 13.9 ± 1.4%; P < .001) and shows good discrimination (observed AUC 0.820; optimism-corrected AUC 0.815). A cut-off of 14.5% yield 78.9% sensitivity and 76.3% specificity. Adding RDW to CRP improve AUC from 0.845 to 0.880 (P = .002). Each 1% RDW increase independently predict active disease (adjusted OR 1.65; 95% CI, 1.30 2.09), including non-anemic patients. In UC, RDW increase with histological severity (P < .001). Conclusion: Red cell distribution width independently reflects objective inflammatory activity in IBD and provides incremental value beyond standard markers, supporting its role as a low-cost adjunct for T2T monitoring.
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