De Roza MA, Lamba M, Goh GBB, Lum JHM, Cheah MCC, Ngu JHJ. Immunoglobulin G in non-alcoholic steatohepatitis predicts clinical outcome: A prospective multi-centre cohort study. World J Gastroenterol 2021; 27(43): 7563-7571 [PMID: 34887649 DOI: 10.3748/wjg.v27.i43.7563]
Corresponding Author of This Article
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. jeffrey.ngu@cdhb.health.nz
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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 jeffrey.ngu@cdhb.health.nz.
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: https://creativecommons.org/Licenses/by-nc/4.0/
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. jeffrey.ngu@cdhb.health.nz
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 Processing time: 213 Days and 23.6 Hours
ARTICLE HIGHLIGHTS
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.
