title: Autoimmune Markers Do Not Impact Clinical Presentation or Natural History of Steatohepatitis-Related Liver Disease.
abstract: OBJECTIVE
  Autoimmune (AI) markers are reported in patients with steatohepatitis-related liver disease. However, their clinical significance is unclear.
  
  
  METHODS
  Charts of patients due to alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) were stratified for antinuclear antigen (ANA > 1:80), antismooth muscle antibody (ASMA > 1:40), or antimitochondrial antibody (AMA > 1:20). Study outcomes were patient survival and complications of liver disease.
  
  
  RESULTS
  Of 607 patients (401 NAFLD), information about AI markers was available for 398 (mean age 50 ± 15 year; 52% males; median body mass index (BMI) 38; 44% diabetic; 62% nonalcoholic steatohepatitis (NASH) as type of steatohepatitis; median MELD score 9). A total of 78 (19.6%) patients were positive for AI markers without differences for ALD versus NAFLD, cirrhosis versus no cirrhosis, and NASH versus no NASH. There were no differences for age, gender, BMI, cirrhosis at presentation, MELD score, endoscopic findings, and histology based on AI markers. Serum ALT was higher among patients with AI markers (65 ± 46 vs. 59 ± 66 IU/l; P = 0.048). Data remained unchanged on analyzing NAFLD patients. None of the 11 ANA-positive patients (1:640 in 4) showed findings of AI hepatitis. Biopsy in three AMA-positive patients showed mild bile duct damage in one patient. On median follow-up of about 3 years, there were no differences in liver disease outcomes (ascites, encephalopathy, variceal bleeding), hepatocellular carcinoma, transplantation, and survival.
  
  
  CONCLUSIONS
  Autoimmune markers are frequently present in steatohepatitis-related liver disease patients. Their presence is an epiphenomenon without histological changes of autoimmune hepatitis. Further, their presence does not impact clinical presentation and follow-up outcomes.
authors.affiliation: Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Sujan
authors.initials: S
authors.lastname: Ravi
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, 35294-0012, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shoreibah
authors.affiliation: Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Raff
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, 35294-0012, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bloomer
authors.affiliation: Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Donny
authors.initials: D
authors.lastname: Kakati
authors.affiliation: Department of Internal Medicine, University of Alabama at Birmingham Montgomery Program, Montgomery, AL, USA.
authors.forename: Khalid
authors.initials: K
authors.lastname: Rasheed
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, 35294-0012, USA. aksingal@uab.edu.
authors.forename: Ashwani K
authors.initials: AK
authors.lastname: Singal
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D005234:Fatty Liver / Q000097:blood / Q000378:metabolism*; D005260:Female; D019693:Hepatitis, Autoimmune / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001323:Autoantibodies; D015415:Biomarkers
keywords: ALD; Autoimmunity; Fatty liver; NAFLD; NASH