Alimentary pharmacology & therapeutics · 2026
Revisiting Ferritin-IgG Score to Predict Complete Biochemical Response in Autoimmune Hepatitis.
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Díaz-González Álvaro, Engel Bastian, Hernández-Guerra Manuel, Pérez-Medrano Indhira, Mateos Beatriz, Morillas Rosa M, Gómez Elena, Gómez Judith, Horta Diana, Conde Isabel, Barrio María Del, Olivas Ignasi, Hajra Ismael El, Riveiro-Barciela Mar, Barreira-Díaz Ana, López Carmen, Álvarez-Navascúes Carmen, Perálvarez Manuel Rodríguez, Jaeckel Elmar, Taubert Richard, Londoño María-Carlota
Аннотация
BACKGROUND: Predictive tools in autoimmune hepatitis (AIH) are scarce. A study proposed low ferritin and high IgG as prognostic markers for complete biochemical response (CBR).
AIMS: We aimed to externally validate the prognostic role of ferritin-IgG score and its individual components in an independent multicentre AIH cohort.
METHODS: This multicentre study included 487 patients from the Hannover cohort (n = 166) and the Spanish ColHai registry (n = 321). Patients with ferritin < 2.09×ULN received 1 point and those with IgG > 1.89×ULN received 1 point, yielding a score of 0-2. Because baseline characteristics differed between cohorts, the score was additionally evaluated after inverse probability of treatment weighting (IPTW) propensity score.
RESULTS: At baseline, Hannover patients were younger (p = 0.005) and had higher transaminases, bilirubin (p < 0.001), ferritin (p = 0.006) and IgG (p = 0.006). Overall, 79.7% achieved CBR; CBR rates were higher in ColHai at 6 (50.2% vs. 34.6%, p = 0.001) and 12 months (67.6% vs. 51.9%, p = 0.001). The score was associated with response in the Hannover cohort but showed no predictive capacity in ColHai (C-statistic 0.51 [95% CI 0.45-0.56] at 6 months; 0.51 [0.45-0.57] at 12 months; 0.54 [0.47-0.61] at any time during the follow-up). After IPTW, the score was not associated with CBR in the ColHai cohort (HR 0.86, 95% CI 0.67-1.10), whereas IgG retained its predictive value, with baseline levels < 1.89×ULN associated with a higher probability of achieving CBR.
CONCLUSIONS: The ferritin-IgG score failed external validation in an independent multicentre cohort. Ferritin showed no prognostic value, whereas the predefined IgG threshold retained its ability to predict treatment response.
AIMS: We aimed to externally validate the prognostic role of ferritin-IgG score and its individual components in an independent multicentre AIH cohort.
METHODS: This multicentre study included 487 patients from the Hannover cohort (n = 166) and the Spanish ColHai registry (n = 321). Patients with ferritin < 2.09×ULN received 1 point and those with IgG > 1.89×ULN received 1 point, yielding a score of 0-2. Because baseline characteristics differed between cohorts, the score was additionally evaluated after inverse probability of treatment weighting (IPTW) propensity score.
RESULTS: At baseline, Hannover patients were younger (p = 0.005) and had higher transaminases, bilirubin (p < 0.001), ferritin (p = 0.006) and IgG (p = 0.006). Overall, 79.7% achieved CBR; CBR rates were higher in ColHai at 6 (50.2% vs. 34.6%, p = 0.001) and 12 months (67.6% vs. 51.9%, p = 0.001). The score was associated with response in the Hannover cohort but showed no predictive capacity in ColHai (C-statistic 0.51 [95% CI 0.45-0.56] at 6 months; 0.51 [0.45-0.57] at 12 months; 0.54 [0.47-0.61] at any time during the follow-up). After IPTW, the score was not associated with CBR in the ColHai cohort (HR 0.86, 95% CI 0.67-1.10), whereas IgG retained its predictive value, with baseline levels < 1.89×ULN associated with a higher probability of achieving CBR.
CONCLUSIONS: The ferritin-IgG score failed external validation in an independent multicentre cohort. Ferritin showed no prognostic value, whereas the predefined IgG threshold retained its ability to predict treatment response.