Not always autoimmune hepatitis: Hepatic steatosis is associated with autoantibodies positivity in patients with hepatocellular dysfunction

Table 1 Patients’ baseline characteristics, n (%)/mean ± SD

Variable	Patients’ characteristics
Gender
Female	57 (70.4)
Male	24 (29.6)
Age (years)	55 ± 15
Cardiometabolic factors
Arterial hypertension	31 (38.3)
T2DM	18 (22.2)
Dyslipidaemia	32 (39.5)
Obesity	26 (32.1)
Previous cardiovascular event	4 (4.9)
Presence of other autoimmune disorders	6 (7.4)
Positivity of autoantibodies
ANA	67 (82.7)
SMA	10 (12.3)
Anti-LKM	5 (6.3)
Anti-LC-1	6 (9.0)
Anti-SLA/LP	13 (16.0)
Elevated IgG levels	21 (29.6)
Histological findings
Hepatic steatosis	39 (48.1)
Lymphocyte infiltrate	55 (67.9)
Interface hepatitis	5 (6.2)
Emperipolesis	0 (0.0)
Hepatocyte rosettes	0 (0.0)
Histological criteria for AIH
Typical	5 (6.2)
Compatible	38 (46.9)
Atypical	38 (46.9)

T2DM: Type 2 diabetes mellitus; ANA: Anti-nuclear antibodies; SMA: Smooth muscle antibodies; Anti-LKM: Anti-liver kidney microsomal antibodies; Anti-LC-1: Anti-liver cytosol type 1; Anti-SLA/LP: Antibodies against soluble liver antigen/Liver pancreas autoantigen; AIH: Autoimmune hepatitis.

Table 2 Sensitivity and specificity of each autoantibody in diagnosing autoimmune hepatitis

Autoantibody	Sensitivity	Specificity
ANA	83.7%	18.4%
SMA	18.6%	94.7%
Anti-LKM	7.0%	94.7%
Anti-LC-1	11.4%	93.8%
Anti-SLA/LP	14.0%	81.6%

ANA: Anti-nuclear antibodies; SMA: Smooth muscle antibodies; Anti-LKM: Anti-liver kidney microsomal antibodies; Anti-LC-1: Anti-liver cytosol type 1; Anti-SLA/LP: Antibodies against soluble liver antigen/Liver pancreas autoantigen.

Table 3 Factors associated with autoimmune hepatitis diagnosis in patients with anti-nuclear antibodies positivity, n (%)/mean ± SD

Variable	AIH diagnosis confirmed (n = 36)	AIH diagnosis not confirmed (n = 31)	P value
Gender
Female	30 (83.3)	18 (58.1)	0.022
Male	6 (16.7)	13 (41.9)
Age (years)	55 ± 16	58 ± 13	0.333
Arterial hypertension	13 (36.1)	14 (45.2)	0.451
T2DM	5 (13.9)	11 (35.5)	0.039
Dyslipidaemia	13 (36.1)	16 (51.6)	0.202
Obesity	8 (22.2)	14 (45.2)	0.046
Previous cardiovascular event	2 (5.6)	2 (6.5)	1.000
Other autoimmune disorders	4 (11.1)	1 (3.2)	0.363
Positivity of autoantibodies
SMA	7 (19.4)	1 (3.2)	0.060
Anti-LKM	2 (5.6)	1 (3.2)	1.000
Anti-LC-1	4 (11.1)	1 (3.2)	0.353
Elevated IgG levels	14 (38.9)	5 (16.1)	0.048
Total bilirubin (mg/dL), median (IQR)	0.67 (0.52)	0.68 (0.60)	0.905
AST (UI/L), median (IQR)	66 (105)	36 (40)	0.092
ALT (UI/L), median (IQR)	85 (154)	50 (54)	0.021
GGT (UI/L), median (IQR)	99 (150)	52 (94)	0.065
ALP (UI/L), median (IQR)	106 (76)	91 (48)	0.258
CAP (dB/m2)	244 ± 60	288 ± 56	0.012
LSM (kPa), median (IQR)	5.4 (3.1)	6.7 (14.9)	0.205

AIH: Autoimmune hepatitis; T2DM: Type 2 diabetes mellitus; SMA: Smooth muscle antibodies; Anti-LKM: Anti-liver kidney microsomal antibodies; Anti-LC-1: Anti-liver cytosol type 1; Anti-SLA/LP: Antibodies against soluble liver antigen/Liver pancreas autoantigen; IQR: Interquartile range; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; CAP: Controlled attenuation parameter; LSM: Liver stiffness measurement; IQR: Interquartile range.

Table 4 Multivariate analysis of predictive factors associated with non-confirmed diagnosis of autoimmune hepatitis in patients with anti-nuclear antibodies positivity

Variable	Exp (B)	95%CI	P value
Male gender	6.883	1.549-30.578	0.011
T2DM	3.944	0.791-19.661	0.094
CAP (dB/m2)	1.014	1.001-1.027	0.034

T2DM: Type 2 diabetes mellitus; CAP: Controlled attenuation parameter.