Abstract
Background and Aims Serum immunoglobulins are frequently increased in patients with chronic liver disease, but little is known about the role of serum immunoglobulins and their correlations with interleukin-27 (IL-27) in patients with HBV-related acute-on-chronic liver failure (HBV-ACLF). This study was aimed at determining the role of serum immunoglobulin (IgG, IgA, and IgM) levels and their associations with IL-27 in noncirrhotic patients with HBV-ACLF. Methods Samples were assessed from thirty patients with HBV-ACLF, twenty-four chronic hepatitis B (CHB) subjects, and eighteen normal controls. Disease severity of HBV-ACLF was evaluated. Serum IL-27 levels were examined by enzyme-linked immunosorbent assay. Immunoglobulin levels were assessed using immunoturbidimetric assay. Correlations between immunoglobulin levels and IL-27 were analyzed. Receiver operating characteristic (ROC) curves were used to predict the 3-month mortality. Results 25 (83.3%) HBV-ACLF patients had elevated serum IgG levels (>1 ULN), 14 (46.7%) patients had elevated IgA, and 15 (50%) had raised IgM. IgG, IgA, and IgM levels were higher in HBV-ACLF patients than in CHB patients and normal controls. Moreover, IgG, IgA, and IgM levels were positively correlated with Tbil levels but negatively correlated with prothrombin time activity (PTA) levels. Additionally, IgG levels were significantly increased in nonsurviving patients than in surviving HBV-ACLF patients (P = 0.007) and positively correlated with MELD score (r = 0.401, P = 0.028). Also, IgG levels were positively correlated with IL-27 levels in HBV-ACLF patients (r = 0.398, P = 0.029). Furthermore, ROC curve showed that IgG levels could predict the 3-month mortality in HBV-ACLF patients (the area under the ROC curve: 0.752, P = 0.005). Conclusions Our findings demonstrated that serum immunoglobulins were preferentially elevated in HBV-ACLF patients. IgG levels were positively correlated with IL-27 and may predict prognosis in HBV-ACLF patients.
Highlights
Acute-on-chronic liver failure (ACLF) is a dramatic clinical syndrome characterized by the sudden loss of hepatic cells leading to multiorgan failure in patients with preexisting chronic liver diseases [1]
There were more patients with serum elevated immunoglobulins levels in the HBV-ACLF group when compared with the chronic hepatitis B (CHB) group for elevated immunoglobulin G (IgG) levels (83.3% vs. 54.2%, P = 0 034), for elevated immunoglobulin A (IgA) levels (46.7% vs. 25%, P = 0 156), and for elevated immunoglobulin M (IgM) levels (50% vs. 8.3%, P = 0 001)
This study shows that there were more patients with elevated immunoglobulin levels in the HBV-ACLF group than in the CHB group; and immunoglobulin (IgG, IgA, and IgM) levels were positively linked with liver injury
Summary
Acute-on-chronic liver failure (ACLF) is a dramatic clinical syndrome characterized by the sudden loss of hepatic cells leading to multiorgan failure in patients with preexisting chronic liver diseases [1]. Characteristic patterns of elevation in serum immunoglobulins are observed in specific liver diseases such as raised immunoglobulin G (IgG) in autoimmune hepatitis, raised immunoglobulin A (IgA) in alcoholic liver disease, and raised immunoglobulin M (IgM) in primary biliary cholangitis (PBC), which can be applied to aid diagnosis in clinical practice [7,8,9,10]. These pieces of evidence strongly link immunoglobulins with immune-mediated liver injury. IgG levels were positively correlated with IL-27 and may predict prognosis in HBV-ACLF patients
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