Published online Nov 21, 2021. doi: 10.3748/wjg.v27.i43.7563
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
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.
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.
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.
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
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.
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.
Further research is needed to validate and reproduce this finding and to also establish the pathophysiology and underlying biochemical mechanisms for this observation.