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
Core Tip

Core Tip: Autoantibodies such as anti-nuclear antibody (ANA) and anti-smooth-muscle antibody (ASMA) can be present in up to 20%-30% of patients with non-alcoholic steatohepatitis (NASH). However, clinical significance is not well studied and there is no published data on the impact of immunoglobulin G (IgG) and plasma cells on hepatic decompensation and mortality outcomes. Our study found that elevated IgG but not ANA, ASMA or plasma cells is associated with higher risk of mortality, including liver related death, as well as increased risk of hepatic decompensation events. Patients with IgG positive NASH should hence be identified early and monitored closely as they are at higher risk of poorer clinical outcomes.