title: The significance of autoantibodies and immunoglobulins in acute liver failure: a cohort study.
abstract: OBJECTIVE
  The cause of cryptogenic ('seronegative') acute liver failure (ALF) is unknown; the presence of non-organ specific autoantibodies (NOSA) may indicate an autoimmune pathogenesis. We investigated the prevalence of autoimmune features including antibodies to soluble liver antigen (anti-SLA) determined by Radioligand assay (RLA) in ALF patients.
  
  
  METHODS
  The prevalence and relationship to the immunoglobulin (Ig) response of NOSA and anti-SLA were determined in 73 ALF patients of different causes. Patients were scored using the revised system for diagnosis of autoimmune hepatitis (AIH).
  
  
  RESULTS
  Autoantibodies were present in 23 (32%) patients; 16 had anti-SLA, 6 ANA, 4 ASM and 1 AMA. They were absent in paracetamol-related disease and present in 23 of 53 (43%) of non-paracetamol (NP) cases (p<0.0003). Two of 16 (13%) with NP drug-induced (NPDI), 9 of 21 (43%) viral and 5 of 16 (31%) cryptogenic cases had anti-SLA. NOSA and anti-SLA were not associated with liver injury severity or outcome. IgM was higher in those with viral disease (p<0.00001). AIH scores classified 50% of cryptogenic cases as 'probable autoimmune hepatitis'.
  
  
  CONCLUSIONS
  Autoantibodies are common in ALF; cryptogenic cases have features suggestive of an autoimmune pathogenesis. IgM is elevated in viral cases but infrequently in ALF of other causes.
authors.affiliation: Institute of Liver Studies, King's College London School of Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
authors.forename: William
authors.initials: W
authors.lastname: Bernal
authors.forename: Yun
authors.initials: Y
authors.lastname: Ma
authors.forename: Heather M
authors.initials: HM
authors.lastname: Smith
authors.forename: Bernard
authors.initials: B
authors.lastname: Portmann
authors.forename: Julia
authors.initials: J
authors.lastname: Wendon
authors.forename: Diego
authors.initials: D
authors.lastname: Vergani
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D000914:Antibodies, Viral / Q000032:analysis / Q000097:blood / Q000276:immunology; D001323:Autoantibodies / Q000032:analysis / Q000097:blood* / Q000276:immunology*; D001324:Autoantigens / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D006505:Hepatitis / Q000276:immunology / Q000503:physiopathology / Q000821:virology; D006801:Humans; D007136:Immunoglobulins / Q000032:analysis / Q000097:blood* / Q000276:immunology*; D017114:Liver Failure, Acute / Q000097:blood* / Q000175:diagnosis / Q000276:immunology*; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011869:Radioligand Assay; D012680:Sensitivity and Specificity
chemical_list: D018712:Analgesics, Non-Narcotic; D000914:Antibodies, Viral; D001323:Autoantibodies; D001324:Autoantigens; D007136:Immunoglobulins; C046431:liver antigen LA-1; D000082:Acetaminophen