Red cell distribution width as a biomarker of disease activity in ulcerative colitis and Crohn’s disease

doi:10.3748/wjg.121569

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Oct 14, 2026; 32(38): 121569
Published online Oct 14, 2026. doi: 10.3748/wjg.121569

Red cell distribution width as a biomarker of disease activity in ulcerative colitis and Crohn’s disease

Yunus H Polat, Başak Çakal, Salim Tece, Ilhami Yuksel

Yunus H Polat, Başak Çakal, Salim Tece, Department of Gastroenterology, Ankara Training and Research Hospital, Ankara 06370, Türkiye

Ilhami Yuksel, Department of Gastroenterology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara 06800, Türkiye

Author contributions: Polat YH contributed to study conception and design, data acquisition, statistical interpretation, manuscript drafting; Çakal B contributed to data collection, clinical interpretation, manuscript revision; Tece S contributed to data collection, literature review, critical revision of the manuscript; Yüksel I contributed to study conception and design, data acquisition, statistical interpretation, manuscript revision; and all authors read and approved the final manuscript and agree to be accountable for all aspects of the work.

AI contribution statement: During the preparation of this manuscript, artificial intelligence-based language tools were used solely for language editing and grammatical improvement. All scientific content, study design, data analysis, interpretation, and final manuscript approval were performed and verified by the authors. AI-based language tools were used during the preparation of the “121569-answering-reviewers” document for language editing and grammatical improvement purposes only. All responses to the reviewers were scientifically prepared, reviewed, and approved by the authors.

Institutional review board statement: This retrospective, single-center cohort study was conducted at the Gastroenterology Department of Ankara Training and Research Hospital after obtaining approval from the Institutional Ethics Committee (Decision No: E-25/735).

Informed consent statement: Informed consent was waived due to the retrospective nature of the study.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.

Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Corresponding author: Yunus H Polat, MD, Associate Faculty, Department of Gastroenterology, Ankara Training and Research Hospital, Mehmet Akif Ersoy Mah., 13. Cadde No:56, Yenimahalle, Ankara 06370, Türkiye. yunushpolat@gmail.com

Received: March 27, 2026
Revised: April 17, 2026
Accepted: May 13, 2026
Published online: October 14, 2026
Processing time: 162 Days and 20.6 Hours

Abstract

BACKGROUND

Red cell distribution width (RDW) has emerged as a potential inflammatory marker in various chronic inflammatory conditions, yet its role in inflammatory bowel disease (IBD) remains insufficiently understood.

AIM

To investigate the association between RDW parameters [RDW-coefficient of variation (RDW-CV) and RDW-standard deviation (RDW-SD)] and disease activity in patients with ulcerative colitis (UC) and Crohn’s disease (CD).

METHODS

This retrospective study included 455 patients diagnosed with IBD (365 UC, 90 CD) who were followed at a tertiary referral center between 2018 and 2025. Disease activity was classified using the UC endoscopic index of severity for UC and the CD activity index for CD. RDW-CV and RDW-SD values were compared across disease activity categories (remission, mild, moderate, severe) and between remission vs active disease groups. Statistical analyses included Mann-Whitney U, Kruskal-Wallis, χ² tests, and receiver operating characteristic analysis. Ethical approval was obtained (E-25/735).

RESULTS

In CD, RDW-CV values were significantly higher in patients with moderate disease activity compared with those in remission and mild activity groups (P = 0.02). However, this significance was observed only across activity categories; when disease activity was dichotomized as remission vs active disease, RDW-CV did not show a significant difference (P = 0.25). In UC, RDW-CV was progressively higher in moderate and severe disease compared with remission and mild disease (P < 0.001). When evaluated as remission vs active disease, RDW-CV was also significantly higher in active UC (P = 0.002). RDW-SD did not show significant differences across activity groups in either disease.

CONCLUSION

RDW-CV is associated with increased disease activity in UC and may partially reflect disease severity in CD. As an inexpensive and easily accessible biomarker, RDW may provide supportive information when evaluating inflammatory burden in IBD; however, prospective multicenter studies are needed to validate its clinical utility. These findings suggest that RDW-CV may serve as a practical adjunct biomarker for disease activity assessment, particularly in settings where endoscopic evaluation is not readily available.

Keywords: Inflammatory bowel disease; Ulcerative colitis; Crohn’s disease; Red cell distribution width; Disease activity

Core Tip: Red cell distribution width (RDW) is an inexpensive and widely available parameter reflecting systemic inflammation. In this study, RDW-coefficient of variation was significantly associated with disease activity in ulcerative colitis, suggesting its potential as a supportive biomarker in clinical practice. However, its utility in Crohn’s disease appears limited.