Notable Publication from the UPMC Division of Gastroenterology, Hepatology and Nutrition

UPMC Division of Gastroenterology, Hepatology and Nutrition faculty published a notable research article in the publication, Annals of Gastroenterology, that explored the association of a high globulin fraction in inflammatory bowel disease (IBD).

Publication Information

Jana G. Hashash, Filippos Koutroumpakis, Alyce M. Anderson, Claudia Ramos Rivers, Mohammad Hosni, Ioannis E. Koutroubakis, Maaz Ahsan, Eugenia Gkiaouraki, Michael A. Dunn, Marc Schwartz, Arthur Barrie, Dmitriy Babichenko, Gong Tang, David G. Binion. Elevated Serum Globulin Fraction as a Biomarker of Multiyear Disease Severity in Inflammatory Bowel Disease. Annals of Gastroenterology. October 2022. https://doi.org/10.20524/aog.2022.0748

Background: The major forms of inflammatory bowel disease (IBD), Crohn’s disease (CD), and ulcerative colitis (UC) are characterized by chronic inflammatory injury to the gastrointestinal tract, leading to cumulative damage and organ dysfunction. In addition to bowel damage, chronic inflammation will often result in changes to routine blood laboratory values; these can include anemia and altered levels of serum proteins, which may rise or fall in the course of the disease. Serum protein reflects albumin and globulin levels, both of which can be altered in inflammatory bowel disease (IBD). The implications of a high globulin fraction in IBD are unknown. The purpose of this study was to assess whether a high globulin fraction may function independently of albumin as a biomarker of disease severity in IBD patients over a multiyear period.

Methods: This was an observational study from a prospective IBD registry of a tertiary care center. High globulin fraction was defined as an elevated globulin level >4 g/dL. Data collected included patient demographics, medication exposures, quality-of-life scores, disease activity, emergency department visits, telephone calls, hospitalizations, and IBD-related surgeries over a four-year period. Comparisons between patients with a high globulin fraction and those without were performed using Pearson’s chi-squared, Student’s and Mann-Whitney tests. Multivariate analyses were used to assess the relationship between high globulin fraction and health care utilization.

Results: A total of 1,767 IBD patients with a four-year follow-up were included: 53.5% female, mean age 48.4±15.1 years, and 65.4% with Crohn’s disease. Of these patients, 446 (25.2%) presented with elevated globulin fraction. Patients with a high globulin fraction were more likely to be hospitalized during the study period. This result remained significant after multivariate analysis for both Crohn’s disease patients and those with ulcerative colitis.

Conclusion: A high globulin fraction is independently associated with greater disease severity and health care utilization in IBD patients. It may function as a routinely available biomarker of a more severe future disease trajectory.