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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical characteristics and outcome of autoimmune pancreatitis based on serum immunoglobulin G4 level: A single-center, retrospective cohort study
Guan-Zhou Zhou, Jia-Qi Zeng, Lei Wang, Miao Liu, Ke Meng, Zi-Kai Wang, Xiu-Li Zhang, Li-Hua Peng, Bin Yan, Fei Pan
Guan-Zhou Zhou, Jia-Qi Zeng, Ke Meng, Zi-Kai Wang, Xiu-Li Zhang, Li-Hua Peng, Bin Yan, Fei Pan, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Guan-Zhou Zhou, School of Medicine, Nankai University, Tianjin 300071, China
Jia-Qi Zeng, Chinese PLA Medical School, Beijing 100853, China
Lei Wang, Department of Rheumatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Miao Liu, Department of Statistics and Epidemiology, Graduate School, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Pan F contributed to study conceptualization and reviewed the manuscript; Zhou GZ and Zeng JQ drafted the initial manuscript and reviewed the manuscript; Wang L and Liu M contributed to methodology and formal analysis; Zhou GZ, Yan B and Meng K contributed to data collection; Wang ZK, Zhang XL and Peng LH reviewed the manuscript; All authors approved the final manuscript as submitted, all authors had full access to the data in the present study and accept responsibility to submit for publication.
Supported by Young Scholar Independent Innovation Science Fund of Chinese PLA General Hospital, No. 22QNCZ020; National Key Research and Development Program, No. 2022YFC2504003.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: As the study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at panfei@plagh.org.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Fei Pan, MD, PhD, Associate Chief Physician, Associate Professor, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. panfei@plagh.org
Received: May 22, 2023
Peer-review started: May 22, 2023
First decision: July 8, 2023
Revised: July 21, 2023
Accepted: September 1, 2023
Article in press: September 1, 2023
Published online: September 21, 2023
ARTICLE HIGHLIGHTS
Research background
The role of immunoglobulin (Ig) G4 in the pathogenesis, diagnosis and prognosis of autoimmune pancreatitis (AIP) has received attention and patients with high levels of IgG4 have unique properties. There is still controversy about the predictors of AIP relapse, such as high IgG4 level, radiological type and steroid use.
Research motivation
To predict the relapse of AIP and identify the properties of patients with different IgG4 level, especially those with normal IgG4 level.
Research objectives
We determined some predictors of relapse and identified unique characteristics of patients with different IgG4 levels. Further studies about improving the diagnosis algorithm of AIP and predicting the relapse are needed.
Research methods
We conducted a retrospective cohort study, including patients with normal IgG4 level (n = 65) and high IgG4 level (n = 148), and compared their clinical characteristics. We also performed univariate and multivariate Cox regression models to investigate the risk factors of relapse.
Research results
Patients with high IgG4 levels had a higher average male age; a higher level of serum total protein, IgG4, and IgE; and a lower level of serum complement C3. In addition, a lower number of cases with abnormal pancreatic duct and pancreatic atrophy and a higher rate of relapse were noted in the abnormal group. Multivariate analyses revealed that serum IgG4 (> 2 × upper limit of normal, ULN) and IgA (> 1 × ULN) and age > 55 years were independent risk factors of relapse.
Research conclusions
Patients with high IgG4 levels had different clinical features including a more active immune system and a higher relapse rate. Some factors were identified as risk factors of relapse, such as age > 55 years, high IgG4 (> 2 × ULN) and IgA level (> 1 × ULN).
Research perspectives
Further research with large samples should be conducted to verify the predictors of relapse.
