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

Autoantibodies, including anti-nuclear antibodies (ANA), are typically present in autoimmune hepatitis (AIH), but may be detected in other liver conditions, including metabolic dysfunction-associated steatotic liver disease (MASLD), even in the absence of an autoimmune disorder.

To identify predictive factors for the non-confirmation of AIH diagnosis in patients with liver dysfunction of unknown etiology and positive autoantibodies.

A retrospective cohort study was conducted in a university-affiliated hospital, including consecutive adult patients with liver dysfunction of unknown etiology and positive autoantibodies typically present in hepatic autoimmune disorders, who underwent liver biopsy, between June 2016 and August 2023. Patients with other known liver diseases or contraindications to liver biopsy were excluded, as well as those who underwent liver biopsy and had a poor specimen quality.

A total of 81 patients were included, of whom 53.1% were diagnosed with AIH and 46.9% with MASLD. ANA had a high sensitivity (83.7%) in diagnosing AIH but the lowest specificity (18.4%). In patients with ANA positivity, male, diabetic and obese individuals were more likely to have a non-confirmed AIH (P = 0.022, P = 0.039 and P = 0.046, respectively). Higher controlled attenuation parameter (CAP) values in patients with ANA positivity were associated with non-confirmed AIH diagnosis (288 ± 56 vs 244 ± 60, P = 0.012). In multivariate analysis, male gender and higher CAP values were independent predictive factors for non-confirmed AIH diagnosis (P = 0.011 and P = 0.034, respectively).

AIH was not confirmed in 47% of patients with liver dysfunction and positive autoantibodies. Multivariate analysis identified male gender and elevated CAP values as independent predictive factors for a non-confirmed diagnosis of AIH in patients with liver dysfunction and ANA positivity. Further prospective and multicenter validation is required in order to corroborate our findings.