Diagnostic value of zonulin, citrulline, and novel hematological indices in pediatric celiac disease
- 1Samsun University, Samsun City Hospital, Department of Medical Microbiology – Samsun, Türkiye.
- 2Samsun City Hospital, Department of Infectious Diseases and Clinical Microbiology – Samsun, Türkiye.
- 3Aydın Adnan Menderes University, Söke Vocational School of Health Services – Aydın, Türkiye.
Abstract
SUMMARY: OBJECTIVE:: The aim of this study was to investigate whether serum zonulin, citrulline, and hemogram-derived inflammatory indices—the systemic immune-inflammation index, systemic inflammation response index, and pan-immune-inflammation value—are associated with newly diagnosed pediatric celiac disease and to characterize their ability to distinguish the study groups.
METHODS:: A total of 82 children, comprising 48 patients with celiac disease and 34 healthy controls, were included. Serum zonulin, citrulline, and tissue transglutaminase immunoglobulin A levels and the systemic immune-inflammation index, systemic inflammation response index, and pan-immune-inflammation value were compared between groups. Receiver operating characteristic analysis was used to describe group discrimination within the selected sample, highlighting the limited standalone utility of these markers.
RESULTS:: Zonulin, tissue transglutaminase immunoglobulin A, the systemic immune-inflammation index, the systemic inflammation response index, and pan-immune-inflammation value were higher in the celiac group (p≤0.024), whereas citrulline did not differ between groups (p=0.982). The area under the receiver operating characteristic curves of pan-immune-inflammation value (0.644), monocyte count (0.642), the systemic immune-inflammation index (0.614), and the systemic inflammation response index (0.612) indicated poor discrimination and did not support their use as stand-alone diagnostic tests. The systemic inflammation response index and pan-immune-inflammation value were strongly correlated (ρ=0.91, p<0.001); this association should be interpreted in view of their shared blood-count components.
CONCLUSION:: Zonulin and hematological inflammation indices are potential markers associated with increased intestinal permeability and systemic inflammation in pediatric celiac disease. Together with tissue transglutaminase immunoglobulin A, these parameters may have an adjunctive role in reflecting disease-related pathophysiological processes; however, their low discriminatory performance precludes their use as stand-alone diagnostic tests.
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BibTeX
@article{bilgin2026diagnostic,
title = {{Diagnostic value of zonulin, citrulline, and novel hematological indices in pediatric celiac disease}},
author = {Melek Bilgin and Hatice Köse and Recai Aci},
journal = {Revista da Associacao Medica Brasileira (1992)},
year = {2026},
month = oct,
doi = {10.1590/1806-9282.20260668},
url = {https://europepmc.org/article/PMC/PMC13722374},
note = {CC BY},
}
RIS
TY - JOUR
TI - Diagnostic value of zonulin, citrulline, and novel hematological indices in pediatric celiac disease
AU - Melek Bilgin
AU - Hatice Köse
AU - Recai Aci
PY - 2026
DA - 2026/10/30
JO - Revista da Associacao Medica Brasileira (1992)
DO - 10.1590/1806-9282.20260668
UR - https://europepmc.org/article/PMC/PMC13722374
AB - SUMMARY: OBJECTIVE:: The aim of this study was to investigate whether serum zonulin, citrulline, and hemogram-derived inflammatory indices—the systemic immune-inflammation index, systemic inflammation response index, and pan-immune-inflammation value—are associated with newly diagnosed pediatric celiac disease and to characterize their ability to distinguish the study groups. METHODS:: A total of 82 children, comprising 48 patients with celiac disease and 34 healthy controls, were included. Serum zonulin, citrulline, and tissue transglutaminase immunoglobulin A levels and the systemic immune-inflammation index, systemic inflammation response index, and pan-immune-inflammation value were compared between groups. Receiver operating characteristic analysis was used to describe group discrimination within the selected sample, highlighting the limited standalone utility of these markers. RESULTS:: Zonulin, tissue transglutaminase immunoglobulin A, the systemic immune-inflammation index, the systemic inflammation response index, and pan-immune-inflammation value were higher in the celiac group (p≤0.024), whereas citrulline did not differ between groups (p=0.982). The area under the receiver operating characteristic curves of pan-immune-inflammation value (0.644), monocyte count (0.642), the systemic immune-inflammation index (0.614), and the systemic inflammation response index (0.612) indicated poor discrimination and did not support their use as stand-alone diagnostic tests. The systemic inflammation response index and pan-immune-inflammation value were strongly correlated (ρ=0.91, p<0.001); this association should be interpreted in view of their shared blood-count components. CONCLUSION:: Zonulin and hematological inflammation indices are potential markers associated with increased intestinal permeability and systemic inflammation in pediatric celiac disease. Together with tissue transglutaminase immunoglobulin A, these parameters may have an adjunctive role in reflecting disease-related pathophysiological processes; however, their low discriminatory performance precludes their use as stand-alone diagnostic tests.
SN - 0104-4230
SN - 1806-9282
ER -