Challenge of liver disease in systemic lupus erythematosus: Clues for diagnosis and hints for pathogenesis

Table 1 Biochemical and histological liver abnormalities in systemic lupus erythematosus patients according to different reports in the literature

Ref.	Study type	Patientswith SLE	NO. of patients with biochemicalalterations and alteration types	Liver histological findings
Mackay et al[11]	Retrospective	19	(n = 19) ↑ AST, ALT	Minimal changes, portal fibrosis, steatosis, inflammation (n = 11) Normal (n = 6) Chronic hepatitis (n = 2)
Chwalińska-Sadowska et al[12]	Retrospective	18	NA	Minimal changes (n = 13) Normal (n =5)
Runyon et al[13]	Retrospective	238	(n = 124) ↑ AST, ALT, total bilirubin, ALP, GGT, LDH (≥ 2 × ULN)	(n = 33) Steatosis (n = 12) Others: cirrhosis, chronic hepatitis, granulomatosis, chronic hepatitis, steatosis, cholestasis, centrilobular necrosis
Gibson et al[14]	Retrospective	81	(n = 64) ↑ AST, ALT, ALP	(n = 7) Portal inflammation (n = 5) Steatosis (n = 1) Chronic hepatitis (n = 1)
Miller et al[15]	Prospective	260	(n = 84) ↑ AST, ALT, ALP	Minimal changes (n = 14)
Matsumoto et al[17]	Retrospective	73	NA	Hepatic arteritis (n = 11) Steatosis (n = 53) RNH (n = 5) Viral hepatitis (n = 2) SLE-PBC overlap syndrome (n = 1) SLE-AIH overlap syndrome (n = 1)
Luangjaru et al[9]	Retrospective	225	(n = 80) ↑ AST, ALT ( ≤ 4 × ULN)	NA
Chowdhary et al[7]	Retrospective	192	(n = 40) ↑ AST, ALT	HCV (n = 3) Steatosis (n =5) SLE-AIH overlap syndrome (n = 4) SLE-PBC overlap syndrome (n = 3) Cryptogenic cirrhosis (n = 1)
Piga et al[3]	Retrospective	242	(n = 59) ↑ AST, ALT (≥ 2 × ULN)	NA
Her et al[138]	Retrospective	141	(n = 46) ↑ Total bilirubin, AST, ALT, LDH, ALP (≥ 2 × ULN)	NA
Huang et al[90]	Retrospective	1533	(n = 134) ↑ AST, ALT (≥ 2 × ULN during 2 yr)	Chronic Hepatitis (n = 6) Minimal changes (n = 4) Normal (n = 3)
Zheng et al[2]	Retrospective	504	(n = 47) ↑ Total bilirubin (13%), ALT (98%), ALP (42%), GGT (49%)	(n = 10) Portal blood cell infiltration (n = 8) Hydropic degeneration (n = 8) Steatosis (n = 2) Mild cholestasis (n = 2) Focal necrosis (n= 1) Nodular cirrhosis (n = 1)
Takahashi et al[18]	Prospective	206	(n = 123) ↑ AST, ALT (99%) ↑ ALP and GGT (81%)	(n = 25) Lupus hepatitis (n = 16): Unspecific reactive hepatitis (88%) Active hepatitis (12%) SLE-AIH overlap syndrome (n = 6): Interface hepatitis (100%) Cirrhosis (33%) SLE-PBC overlap syndrome (n = 3)

SLE: Systemic lupus erythematosus; ULN: Upper limit of normal; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; LDH: Lacto dehydrogenase; ALP: Alkaline phosphatase; GGT: Gamma glutamil transferase; HCV: Hepatitis C virus; PBC: Primary biliary cirrhosis; AIH: Autoimmune hepatitis.