Revisiting Ferritin‐ IgG Score to Predict Complete Biochemical Response in Autoimmune Hepatitis
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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.
DOI: 10.1111/apt.71014
Authors: Álvaro Díaz‐González, Bastian Engel, Manuel Hernández‐Guerra, Indhira Pérez‐Medrano, Beatriz Mateos, Rosa M. Morillas, Elena Gómez, Judith Gómez, Diana Horta, Isabel Conde, María Del Barrio, Ignasi Olivas, Ismael El Hajra, Mar Riveiro‐Barciela, Ana Barreira‐Díaz, Carmen López, Carmen Álvarez‐Navascúes, Manuel Rodríguez Perálvarez, Elmar Jaeckel, Richard Taubert, María‐Carlota Londoño
Institutions: Marqués de Valdecilla University Hospital, Instituto de Investigación Marqués de Valdecilla, Medizinische Hochschule Hannover, ERN RARE-LIVER, Hospital Universitario de Canarias, Complejo Hospitalario de Pontevedra, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Hospital Universitario Ramón y Cajal, Universitat Autònoma de Barcelona, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Hospital Universitario 12 De Octubre, Hospital Universitario de Burgos, University Hospital Mútua de Terrassa, Mútua Terrassa, Instituto de Salud Carlos III, Hospital Universitari i Politècnic La Fe, Instituto de Investigación Sanitaria La Fe, Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Hospital Universitario Puerta de Hierro Majadahonda, Vall d'Hebron Hospital Universitari, Hospital Universitari de Girona Doctor Josep Trueta, Hospital Universitario Central de Asturias, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, University Health Network, University of Toronto, Toronto General Hospital, Universitat de Barcelona
Language: English
Topic: Liver Diseases and Immunity
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,250
OpenAlex ID: W7214738437