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Practical Predictors of Fibrosis in Non-alcoholic Fatty Liver Disease: Immunoglobulin-A and HOMA-IR



Objective: Elevated immunoglobulin (Ig)-A levels and its relationship with fibrosis in alcoholic liver disease (ALD) were known. Non-alcoholic fatty liver disease (NAFLD) shows similar histology and pathophysiology with ALD. The potential relationship of serum Ig (IgA, IgG, and IgM) levels and other routinely used biochemical tests with the histological stage of liver damage in biopsy-proven NAFLD patients was investigated here.

Methods: Seventy patients and 54 volunteers as controls were included. 

Results: No statistical difference was found between NAFLD vs controls and non-alcoholic steatohepatitis (NASH) [n = 53] vs non-NASH (n = 17) in terms of Ig levels. When NAFLD patients with normal and elevated IgA levels were compared NASH and diabetes mellitus ratios were found higher in the latter group.Serum IgA levels were significantly correlated with the stage of fibrosis                 (r = 0.636, p < 0.001). When NAFLD patients were compared as patients with no/mild fibrosis and patients with advanced fibrosis IgA, age, gender, homeostasis model of insulin resistance (HOMA-IR), and body-mass indexwere all significantly higher in advanced fibrosis subgroup, furthermore IgA and HOMA-IR were established as the independent predictors of fibrosis by logistic regression analysis. When IgA levels were evaluated by ROC analysis to differentiate advanced fibrosis from mildfibrosis, AUC was 0.874 at the cut-off level of 391.5 mg/dL for IgA with 78.9% sensitivity and 88.2% specificity.

Conclusions: Serum IgA levels showed a stepwise increase with the increasing fibrosis stages in NAFLD patients. HOMA-IR and serum IgA are independent predictors of fibrosis that can be easily accessed in daily practice.


08 Aug, 2018
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e-Published: 14 Feb, 2019


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