Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2021; 27(43): 7563-7571
Published online Nov 21, 2021. 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, Mehul Lamba, George Boon-Bee Goh, Johnathan Huey-Ming Lum, Mark Chang-Chuen Cheah, Jing Hieng Jeffrey Ngu
Marianne Anastasia De Roza, Johnathan Huey-Ming Lum, Department of Gastroenterology and Hepatology, Sengkang General Hospital, Singhealth, Singapore 544886, Singapore
Mehul Lamba, Jing Hieng Jeffrey Ngu, Department of Gastroenterology and Hepatology, Christchurch Hospital, Christchurch 8011, New Zealand
George Boon-Bee Goh, Mark Chang-Chuen Cheah, Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169608, Singapore
George Boon-Bee Goh, Duke-NUS Medical School, Singapore 169608, Singapore
Author contributions: De Roza MA contributed to study design, data collection and analysis, manuscript writing, critical Review and submission of manuscript; Lamda M contributed to study design, data collection and analysis, manuscript writing and review of manuscript; Goh GBB contributed to study design and critical review of manuscript; Cheah MCC and Lum JHM contributed to data collection; Ngu JHJ contributed to study design, writing and critical review of manuscript; and all authors read and approved the final manuscript.
Institutional review board statement: This study conforms to ethical guidelines and was approved by our institutional review board with waiver of patient consent.
Clinical trial registration statement: This study does not include any intervention and is not a randomized controlled trial.
Informed consent statement: Consent was not obtained as data was anonymized and protected with little to no risk of identification.
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.
Data sharing statement: Statistical code, and dataset is available from the corresponding author at
CONSORT 2010 statement: The manuscript was checked according to the CONSORT 2010.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jing Hieng Jeffrey Ngu, MBChB, FRACP, PhD, Academic Research, Consultant Physician-Scientist, Doctor, Department of Gastroenterology and Hepatology, Christchurch Hospital, Riccarton Avenue, Christchurch 8011, New Zealand.
Received: April 19, 2021
Peer-review started: April 19, 2021
First decision: June 23, 2021
Revised: July 20, 2021
Accepted: November 2, 2021
Article in press: November 2, 2021
Published online: November 21, 2021
Research background

Autoimmune markers such as immunoglobulin G (IgG), anti-nuclear antibody (ANA), anti-smooth-muscle antibody (ASMA) can be present in patients with Non-alcoholic steatohepatitis (NASH) but their clinical significance is not well studied.

Research motivation

Knowing the clinical significance of autoimmune markers in patients with biopsy proven NASH can pave the way for future research to better understand why certain sub-groups of patients with NASH deteriorate more rapidly.

Research objectives

This study aimed to determine if any of the autoimmune markers were independently associated with worse outcomes such as mortality and hepatic decompensation. This is important as such patients can be identified for closer monitoring.

Research methods

This is a prospective, multi-center study. Patients with biopsy proven NASH were included and multivariate analysis was performed to determine if any of the autoimmune markers (IgG, ANA, ASMA) were independent risk factors for mortality and hepatic decompensation

Research results

Elevated IgG was an independent risk factor for both mortality and liver decompensation after multivariate analysis with adjustment for age and fibrosis stage. The exact pathophysiology is unknown but IgG levels could possibly correlate to disease severity due to anti-endotoxins IgG and oxidative stress.

Research conclusions

Elevated IgG is an independent predictor of increased risk of liver decompensation and reduced survival in patients with NASH. It could represent a more aggressive NASH phenotype.

Research perspectives

Further research is needed to validate and reproduce this finding and to also establish the pathophysiology and underlying biochemical mechanisms for this observation.