Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2023; 11(32): 7753-7760
Published online Nov 16, 2023. doi: 10.12998/wjcc.v11.i32.7753
Appropriate leucine-rich α-2 glycoprotein cut-off value for Japanese patients with ulcerative colitis
Masanao Yamazato, Shunichi Yanai, Tomofumi Oizumi, Makoto Eizuka, Shun Yamada, Yosuke Toya, Noriyuki Uesugi, Tamotsu Sugai, Takayuki Matsumoto
Masanao Yamazato, Shunichi Yanai, Tomofumi Oizumi, Makoto Eizuka, Shun Yamada, Yosuke Toya, Takayuki Matsumoto, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Yahaba 028-3695, Japan
Noriyuki Uesugi, Tamotsu Sugai, Division of Molecular Diagnostic Pathology, Iwate Medical University, Yahaba 028-3695, Japan
Author contributions: Yamazato M, and Yanai S performed the conception and design; Yamazato M, Yanai S, Oizumi T, Eizuka M, Yamada S, Toya Y, Uesugi N, and Sugai T performed the data collection; Yamazato M, and Yanai S contributed to the data analysis and statistical analysis; The first draft of manuscript was written by Yamazato M, and Yanai S; Matsumoto T critically reviewed and revised the manuscript; All authors read and approved the final manuscript for submission.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Iwate Medical University Hospital.
Informed consent statement: Patients were not required to give informed consent as this is a retrospective study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
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: Shunichi Yanai, Doctor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba 028-3695, Japan. syanai@iwate-med.ac.jp
Received: May 22, 2023
Peer-review started: May 22, 2023
First decision: August 8, 2023
Revised: August 18, 2023
Accepted: November 2, 2023
Article in press: November 2, 2023
Published online: November 16, 2023
Processing time: 177 Days and 18.1 Hours
Abstract
BACKGROUND

It has been suggested that serum leucine-rich α-2 glycoprotein (LRG) could be a novel monitoring biomarker for the assessment of disease activity in inflammatory bowel disease. In particular, the relationship between LRG levels and the endoscopically assessed activity of ulcerative colitis (UC) has become a matter of interest.

AIM

To clarify appropriate LRG cut-off values for the prediction of endoscopic and histologic remission in Japanese patients with UC.

METHODS

This was a cross-sectional, single-center, observational study of Japanese patients with UC. Among 213 patients with UC, in whom LRG was measured from September 2020 to February 2022, we recruited 30 patients for whom a total colonoscopy and measurements of LRG and C-reactive protein (CRP) were performed on the same day. We retrospectively analyzed correlations between the LRG and CRP levels and endoscopic indices, including the Mayo endoscopic subscore and UC endoscopic index of severity.

RESULTS

Correlations between the LRG values and the Mayo endoscopic subscore or UC endoscopic index of severity were significant (r = 0.754, P < 0.0001; r = 0.778, P < 0.0001, respectively). There were also significant correlations between CRP levels and Mayo endoscopic subscore or UC endoscopic index of severity (r = 0.599, P = 0.0005; r = 0.563, P = 0.0012, respectively), although the correlation coefficients were higher for LRG. The LRG cut-off value for predicting endoscopic remission was 13.4 μg/mL for a Mayo endoscopic subscore of 0 [area under the curve (AUC): 0.871; 95% confidence interval (CI): 0.744–0.998], and 13.4 μg/mL for an UC endoscopic index of severity of 0 or 1 (AUC: 0.904; 95%CI: 0.792–1.000).

CONCLUSION

LRG may be a surrogate marker for endoscopic activity in UC, with a cut-off value of around 13.4 μg/mL for endoscopically inactive disease.

Keywords: Ulcerative colitis; Leucine-rich alpha-2 glycoprotein; C-reactive protein; Japanese patients

Core Tip: Leucine-rich α-2 glycoprotein (LRG) has recently been proposed as a reliable surrogate marker for clinical, endoscopic and histologic activity in ulcerative colitis (UC). Our aim was to determine appropriate LRG cut-off values for predicting clinical and endoscopic remission in Japanese patients with UC. LRG was found to be correlated with endoscopic indices, and the LRG cut-off value for predicting endoscopic remission was determined to be 13.4 μg/mL. LRG < 13.4 μg/mL may be predictive of endoscopically inactive disease in UC.