Computed Tomography and Plasma Proteomics for Early Discrimination of Post-Pancreatitis Diabetes Mellitus

BACKGROUND There is a lack of effective predictive methods for post-pancreatitis diabetes mellitus (PPDM-A) in clinical practice. This exploratory study aimed to identify candidate computed tomography (CT) and plasma proteomic features associated with subsequent PPDM-A and to assess their preliminary discriminatory performance. MATERIAL AND METHODS This retrospective single-center study compared CT imaging features and clinical data between post-pancreatitis normal glucose (PPNG-A, n=10) and PPDM-A (n=9) groups. Differential plasma protein expression was analyzed using proteomics. Correlations between CT features and protein features in patients with PPDM-A were also assessed. RESULTS The PPDM-A group showed higher incidences of pancreatic necrosis and elevated plasma complement factor I (CFI) levels compared with the PPNG-A group. Plasma coagulation factor XII (F12) and immunoglobulin heavy chain (IgH) levels were significantly decreased in the PPDM-A group. Enzyme-linked immunosorbent assay findings validated CFI; F12 and IgH remain proteomics-derived candidate markers. The combined 3-index model achieved an area under the curve of 0.989 for PPDM-A discrimination in the same discovery cohort. CFI was positively correlated with pancreatic necrosis (P=0.02, R=0.527). CONCLUSIONS Plasma CFI, F12, and IgH demonstrated potential predictive value for PPDM-A and may help identify at-risk patients. CFI and F12 were significantly correlated with pancreatic necrosis, suggesting a link between plasma molecular markers and imaging manifestations of PPDM-A. These exploratory findings provide a preliminary experimental basis for early discrimination of PPDM-A. Clinical utility requires confirmation in multicenter studies with larger sample sizes and both internal and external validation.