Diagnostic value of zonulin, citrulline, and novel hematological indices in pediatric celiac disease
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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.
Authors: Melek Bilgin, Hatice Köse, Recai Aci
Institutions: Samsun University, Adnan Menderes University
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224886143