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. 2023 Jun 20;12(12):4170.
doi: 10.3390/jcm12124170.

Total Globulin Fraction at Diagnosis Could Forecast All-Cause Mortality during the Disease Course in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Jang-Woo Ha  1 , Sung-Soo Ahn  1 , Jason-Jungsik Song  1   2 , Yong-Beom Park  1   2 , Sang-Won Lee  1   2
Affiliations

Total Globulin Fraction at Diagnosis Could Forecast All-Cause Mortality during the Disease Course in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Jang-Woo Ha et al. J Clin Med. .

Abstract

Total globulin fraction (TGF) is calculated by subtracting serum albumin levels from serum total protein levels. The present study examined whether TGF at diagnosis could forecast all-cause mortality during the disease course in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The present study included 283 patients with AAV. The variables at AAV diagnosis such as demographic data, AAV-specific data including the Birmingham vasculitis activity score (BVAS), five-factor score (FFS), and laboratory data including ANCA, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were collected. The number of deceased patients during the follow-up duration based on all-cause mortality was counted. The median age of the 283 AAV patients was 60 years, and 35.7% were men. ANCAs were detected in 228 patients, and the median TGF was 2.9. A total of 39 patients (13.8%) died within a median follow-up duration of 46.9 months. TGF at AAV diagnosis was significantly correlated with ESR and CRP rather than AAV activity. Patients with ANCA positivity exhibited a significantly higher median TGF at AAV diagnosis than those without. Patients with TGF ≥ 3.1 g/dL at AAV diagnosis exhibited a significantly lower cumulative survival rate than those without. Furthermore, in the multivariable Cox hazards model analysis, TGF ≥ 3.1 g/dL (hazard ratio 2.611) was independently associated with all-cause mortality, along with age, male sex, and body mass index. The present study is the first to demonstrate that TGF at AAV diagnosis can forecast all-cause mortality during the disease course in AAV patients.

Keywords: antineutrophil cytoplasmic antibody; fraction; globulin; mortality; vasculitis.

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Conflict of interest statement

The authors declare no conflict of interest that influence the representation or interpretation of the reported research results.

Figures

Figure 1
Figure 1
Comparative analysis of TGF at AAV diagnosis according to AAV subtype, sex, ANCA positivity, and ANCA type. TGF: the total globulin fraction; AAV: ANCA-associated vasculitis; ANCA: antineutrophil cytoplasmic antibody; MPA: microscopic polyangiitis; GPA: granulomatosis with polyangiitis; EGPA: eosinophilic granulomatosis with polyangiitis; MPO: myeloperoxidase; P: perinuclear; PR3: proteinase 3; C: cytoplasmic.
Figure 2
Figure 2
The ROC curve analysis for obtaining the cut-off of TGF for all-cause mortality. ROC: receiver operating characteristics; TGF: the total globulin fraction; AUC: area under the curve; AAV: ANCA-associated vasculitis; ANCA: antineutrophil cytoplasmic antibody.
Figure 3
Figure 3
Comparative analysis of cumulative survival rates according to the cut-off of TGF for all-cause mortality. TGF: the total globulin fraction; AAV: ANCA-associated vasculitis; ANCA: antineutrophil cytoplasmic antibody.
Figure 4
Figure 4
Hypothesis on the mechanism of how TGF at AAV diagnosis could forecast all-cause mortality during the disease course of AAV. TGF: the total globulin fraction; AAV: ANCA-associated vasculitis; ANCA: antineutrophil cytoplasmic antibody.
See this image and copyright information in PMC

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