Nonstandard antibodies as prognostic markers in autoimmune hepatitis.

BACKGROUND

Antibodies to actin, chromatin, soluble liver antigen/liver pancreas and liver cytosol type 1 have been ascribed prognostic value in autoimmune hepatitis.

AIM: Evaluate the performance parameters of these nonstandard autoantibodies and determine the critical battery for clinical application.

METHODS

All antibodies were tested concurrently by enzyme immunoassay in 106 patients who had reached a treatment outcome. Tests were repeated in 149 serum samples obtained later to assess durability of the findings.

RESULTS

Antibodies to chromatin and soluble liver antigen/liver pancreas were superior to the other markers in predicting relapse. Patients with antibodies to chromatin and/or soluble liver antigen/liver pancreas relapsed more frequently than patients without these markers (100 versus 79%, p < 0.0003). Maximum sensitivity and predictability for relapse required combined testing, and they were 54 and 60%, respectively. Antibody status remained stable in 60% of patients during 127 +/- 9 months of follow-up, and antibodies to soluble liver antigen/liver pancreas were less labile than antibodies to chromatin (frequency of status change, 4 versus 22%). None of the antibodies were associated with treatment failure, death from hepatic failure or requirement for liver transplantation.

CONCLUSIONS

Antibodies to chromatin and soluble liver antigen/liver pancreas are associated with relapse after corticosteroid withdrawal, and they may be useful prognostic markers. Combined testing improves but does not eliminate deficiencies in sensitivity, predictability and durability.