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Multicenter Study
. 2021 Nov 21;27(43):7563-7571.
doi: 10.3748/wjg.v27.i43.7563.

Immunoglobulin G in non-alcoholic steatohepatitis predicts clinical outcome: A prospective multi-centre cohort study

Marianne Anastasia De Roza  1 , Mehul Lamba  2 , George Boon-Bee Goh  3 , Johnathan Huey-Ming Lum  1 , Mark Chang-Chuen Cheah  3 , Jing Hieng Jeffrey Ngu  4
Affiliations
Multicenter Study

Immunoglobulin G in non-alcoholic steatohepatitis predicts clinical outcome: A prospective multi-centre cohort study

Marianne Anastasia De Roza et al. World J Gastroenterol. .

Abstract

Background: Autoimmune markers including plasma cells (PC), anti-smooth-muscle antibody (ASMA), anti-nuclear antibody (ANA), and raised immunoglobulin G (IgG) are commonly observed in non-alcoholic steatohepatitis (NASH), however their clinical significance is unknown.

Aim: To determine if autoimmune markers in NASH patients are independently associated with poorer clinical outcomes.

Methods: Consecutive patients with biopsy proven NASH from Christchurch Hospital, New Zealand and Singapore General Hospital (SGH) were included between 2005 to 2016 in a prospective multi-centre cohort study. Patients with other causes of chronic liver disease were excluded. IgG > 14 g/L or globulin fraction > 50%, ANA ≥ 1:40, SMA ≥ 1:40 were considered positive. Multivariate analysis was performed to assess which markers were independently associated with mortality and hepatic decompensation.

Results: Total 261 patients were included of which 201 were from SGH. The median age was 53 and 51.9% were male. Advanced fibrosis was present in 31.4% at diagnosis. PC, ASMA, ANA and raised IgG were observed in 13.1%, 4.9%, 27.8% and 30.1% of patients respectively. After multivariate analysis, elevated IgG [Hazard Ratio (HR) 6.79, 95%CI: 2.93-17.15] and fibrosis stage (HR 1.37, 95%CI: 1.03-1.87) were found to be independently associated with increased risk of liver decompensation. Age (HR 1.06, 95%CI: 1.02-1.10) and elevated IgG (HR 3.79, 95%CI: 1.90-7.68) were independent factors associated with higher mortality risk.

Conclusion: Elevated IgG, rather than ANA, ASMA or plasma cells, is independently associated with increased risk of hepatic decompensation and mortality in NASH. It could hence be important for prognostication.

Keywords: Autoantibodies; Hepatic decompensation; Immunoglobulin G; Mortality; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis.

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Conflict of interest statement

Conflict-of-interest statement: All authors declare there are no conflicts of interest. None of the authors received financial support or grants for this study.

Figures

Figure 1
Figure 1
Overall risk of liver decompensation and all cause mortality. A: Overall risk of liver decompensation; B: Overall risk of all cause mortality.
Figure 2
Figure 2
Raised immunoglobulin G and risk of liver decompensation and mortality on multivariate analysis. A: Raised immunoglobulin G (IgG) and risk of liver decompensation; B: Raised IgG and risk of all-cause mortality; C: Raised absolute IgG > 14 and risk of liver decompensation. IgG: Immunoglobulin G.
See this image and copyright information in PMC

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