EXPRESS: Redox Imbalance and Systemic Inflammation in Celiac Disease: Differential Diagnostic Performance of Oxidative Stress Biomarkers

BackgroundOxidative stress has been implicated in the pathophysiology of celiac disease; however, its relationship with disease activity and its interplay with systemic inflammatory indices remain incompletely defined.PurposeTo evaluate the association between oxidative stress and disease activity in celiac disease and to compare the discriminative performance of oxidative stress biomarkers with systemic inflammatory indices.Study TypeProspective observational cross-sectional study.PopulationA total of 148 adults comprising 45 patients with active celiac disease, 42 patients with celiac disease in remission, and 61 controls.Assessment Technique(s) or Outcome(s)Oxidative stress was assessed using ischemia-modified albumin (IMA), the IMA/albumin ratio (IMAR), and thiol-disulfide homeostasis parameters. Systemic inflammatory indices, including platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII), were derived from routine hematological parameters. The primary outcome was the comparison of oxidative stress parameters and systemic inflammatory indices among the three study groups; discriminative performance for active disease versus remission was evaluated as a secondary outcome.Statistical TestsGroup comparisons were performed using one-way analysis of variance with post hoc testing. Pearson correlation analysis was used to assess associations between inflammatory and oxidative stress parameters. Receiver operating characteristic analysis and multivariable binary logistic regression were used to evaluate discriminative performance and independent associations with active disease.ResultsIMA and IMAR were significantly higher and native and total thiol levels were significantly lower in active celiac disease (all p<0.001). PLR and SII differed among groups, with higher mean values in active disease, whereas other inflammatory indices did not differ significantly. IMA showed the highest discriminative performance for active disease versus remission (AUC=0.843, 95% CI 0.761-0.924), followed by IMAR (AUC=0.832, 95% CI 0.748-0.916). PLR and SII showed lower discriminative performance (AUC=0.625 and 0.602, respectively). In multivariable analyses, IMA and IMAR remained independently associated with active disease.Data ConclusionOxidative stress-related biomarkers, particularly IMA and IMAR, were associated with active celiac disease and showed higher observed AUCs than systemic inflammatory indices. Longitudinal studies are needed to determine their utility for disease monitoring.