Immunoglobulin G Levels as a Prognostic Factor for Autoimmune Hepatitis Combined With Systemic Lupus Erythematosus

Abstract

Objective. Autoimmune hepatitis (AIH) is a chronic progressive liver disease characterized by circulating autoantibodies and hyperglobulinemia. This study was conducted to identify the features of AIH accompanied by systemic lupus erythematosus (SLE-AIH) that differ from those of primary AIH (P-AIH), and to evaluate factors that affect the outcome for SLE-AIH patients. Methods. From May 1995 to April 2014, clinical data (including liver pathology) from 164 patients with P-AIH and 23 patients with SLE-AIH were collected from an electronic database at a tertiary referral center. AIH was diagnosed according to the diagnostic scoring system for AIH (revised in 1999). SLE patients fulfilled at least 4 of the 1997 revised American College of Rheumatology criteria. Progression was defined as occurrence of cirrhosis, hepatocellular carcinoma, liver transplantation, or death from hepatic failure. Results. The age at the time of AIH diagnosis was lower and initial levels of serum IgG were higher in SLE-AIH than in P-AIH patients. Progression was more common in P-AIH, and hepatocellular carcinoma, liver transplantation, or death occurred only in P-AIH patients. Among 23 patients with SLE-AIH, 8 with cirrhosis had higher levels of serum IgG than 15 patients without cirrhosis (mean 6 SD 4,077.4 6 1,641.0 mg/dl and 2,560.7 6 932.2 mg/dl, respectively; P 5 0.017). Moreover, a serum IgG level more than 2-fold the upper normal limit was associated with a high risk of cirrhosis in SLE-AIH (odds ratio 11.00 [95% confidence interval 1.420-85.201]; P 5 0.026). Conclusion. Initially high levels of serum IgG are a poor prognostic factor for SLE-AIH. Additionally, the long-term outcome for SLE-AIH might be better than for P-AIH.

Proteomic analysis identified salivary immunoglobulin gamma-3 chain C as a potential biomarker for systemic lupus erythematosus

“…Elevated level of serum IgG is a poor prognostic factor for autoimmune hepatitis associated with SLE. Additionally, the deposition of IgG is reported to cause tissue damage [24,25]. The serum IgG levels correlated with the serologic activity and can predict disease ares in patients with LN.…”

Autoimmune Hepatitis: The Third Autoimmune Disease in a Young Female

“…Although SLE affects various organ systems, liver involvement is usually not part of the disease spectrum [3,4]. The reasons of deranged liver enzymes in SLE patients are hepatotoxic drugs, viral hepatitis, fatty liver disease associated with steroid use and less commonly primary liver disease, hepatic congestion or lupus hepatitis [2]. It is quite rare to find an autoimmune hepatitis and SLE overlap and is usually considered when patients fulfill the American College of Rheumatology criteria for systemic lupus erythematous and International autoimmune hepatitis group scoring for AIH [5].…”

“…Doo Ho Lim et al showed that patients with SLE -AIH overlap and have much higher levels of IgG than those with primary autoimmune hepatitis and that those with SLE -AIH patients who had cirrhosis had higher levels of IgG than those without cirrhosis. They also noticed that the serum IgG levels normalized in patients with SLE-AIH without cirrhosis after treatment suggesting that IgG can be used as a marker for prognosis in SLE-AIH [2].…”

“…It predominantly affects women and its sequale are cirrhosis, liver failure and death [1]. Autoimmune hepatitis at times might coexist with other diseases such as hemolytic anemia, thyroiditis, immune thrombocytopenia, rheumatoid arthritis and systemic lupus erythematous [2].…”

Micro-bead injection spectroscopy for label-free automated determination of immunoglobulin G in human serum

“…The level of serum IgG is also a valuable predictor for the risk of infection in transplant recipients [8][9][10]. Moreover, high IgG levels are indicators of autoimmunity (e.g., demyelinating diseases, lupus erythematosus), chronic infection, liver diseases (e.g., autoimmune hepatitis), and lymphoproliferative disorders (e.g., multiple myeloma) [3,[11][12][13][14]. The early diagnosis of these conditions is a key factor to minimize the risk of permanent organ damage and to proceed with adequate therapy, accounting for less morbidity and mortality [14,15].…”