title: Frequency and risk factors of low immunoglobulin levels in patients with inflammatory bowel disease.
abstract: OBJECTIVE
  Inflammatory bowel diseases (IBD) are considered to be dysregulated, immune-mediated disorders; and immunosuppressive medications are the mainstay of their treatment. Clinically, we have often observed low serum immunoglobulin (Ig) levels in these patients. The aim of this study was to assess the frequency and risk factors of secondary humoral immunodeficiency in IBD patients.
  
  
  METHODS
  We conducted a cross-sectional study of eligible IBD patients with Crohn's disease (CD), ulcerative colitis (UC), indeterminate colitis (IC) or restorative proctocolectomy with ileal pouch, who having serum Ig measured. Demographic and clinical variables were measured. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  A total of 324 patients was included, with a mean age of 38.8 years and 158 (48.8%) being male. Low IgG, IgG1, IgA, and IgM were found in 22.7%, 23.4%, 7.9%, and 10.9% of patients, respectively. The shared risk factors for a low IgG or IgM level were increasing age [odds ratio (OR) = 1.13; 95% confidence interval (CI) 1.03-1.23 for low IgG level and OR = 1.33; 95% CI 1.15-1.56 for low IgM level] and hypoalbuminemia (OR = 1.83; 95% CI 1.01-3.33 for low IgG level and OR = 3.17; 95% CI 1.23-8.15 for low IgM level). In addition, thioprine use was associated with low IgA level (OR = 2.76; 95% CI 1.03-7.39). IBD disease duration was a risk factor for low IgG1 level (OR = 1.40; 95% CI 1.12-1.76). The presence of concurrent primary sclerosing cholangitis (OR = 0.064; 95% CI 0.007-0.60) and the use of biologics (OR = 0.16; 95% CI 0.033-0.79) were associated with normal IgG1 level. IgG level was lower in CD patients than that in UC/IC and ileal pouch patients (P = 0.042). IgG and IgA levels were elevated in patients with inflammatory conditions of the pouch (P = 0.01; P = 0.003, respectively).
  
  
  CONCLUSIONS
  Low Ig level appears to be common in IBD patients. Increasing age, disease duration and hypoalbuminemia appeared to be risk factors. The findings may provide rationale for targeted therapy to boost humoral immunity in selected patients with IBD.
authors: Departments of General Internal Medicine and Gastroenterology/Hepatology, the Cleveland Clinic Foundation, Cleveland, OH, USA.
authors: Tarun
authors: T
authors: Rai
authors: Departments of General Internal Medicine and Gastroenterology/Hepatology, the Cleveland Clinic Foundation, Cleveland, OH, USA.
authors: Xianrui
authors: X
authors: Wu
authors: Departments of General Internal Medicine and Gastroenterology/Hepatology, the Cleveland Clinic Foundation, Cleveland, OH, USA shenb@ccf.org.
authors: Bo
authors: B
authors: Shen
keywords: Crohn’s disease; biologics; ileal pouch; immunoglobulins; inflammatory bowel disease; ulcerative colitis
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