Secretory IgA Is a Key Marker Among Gut Barrier Dysfunction-Related Immunoglobulins Predicting Outcomes in ACLF

Area of Science:

• Immunology
• Gastroenterology
• Hepatology

Background:

• Impaired gut immunity in cirrhosis allows bacterial translocation, worsening liver damage.
• The role of antibody-mediated immunity in cirrhosis progression is not fully understood.

Purpose of the Study:

• To investigate serum immunoglobulins (Ig) as prognostic markers for gut barrier function in acutely decompensated (AD) cirrhosis.
• To assess the predictive value of IgA and IgG antibodies for mortality in cirrhosis patients.

Main Methods:

• Serum samples from 128 AD cirrhosis patients were analyzed for various IgA, IgG, IgM, and light chain levels.
• Specific antibodies against gut-related targets were measured.
• Mortality was tracked for 90 days, with validation in an independent ACLF cohort.

Main Results:

• Elevated total-IgA and target-specific IgA antibodies correlated with disease severity.
• Secretory IgA (sIgA) levels increased with ACLF severity and predicted 90-day mortality in ACLF patients (AUROC: 0.859).
• High sIgA independently predicted 90-day mortality in a merged ACLF cohort (HR: 3.367).

Conclusions:

• Increased IgA antibodies suggest enhanced bacterial translocation-triggered immune activation in cirrhosis.
• Serum sIgA is a promising biomarker for gut barrier dysfunction and predicting 90-day mortality in ACLF.