{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T08:16:00Z","timestamp":1788336960683,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T00:00:00Z","timestamp":1772928000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T00:00:00Z","timestamp":1772928000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["ME 3696\/3"],"award-info":[{"award-number":["ME 3696\/3"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner-Fresenius-Stiftung","doi-asserted-by":"publisher","award":["2020_EKSP.78"],"award-info":[{"award-number":["2020_EKSP.78"]}],"id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner-Fresenius-Stiftung","doi-asserted-by":"publisher","award":["2024_EKTP01"],"award-info":[{"award-number":["2024_EKTP01"]}],"id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010570","name":"Nieders\u00e4chsisches Ministerium f\u00fcr Wissenschaft und Kultur","doi-asserted-by":"publisher","award":["ZN3720"],"award-info":[{"award-number":["ZN3720"]}],"id":[{"id":"10.13039\/501100010570","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,4]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background & Aims<\/jats:title>\n The distinction of drug\u2010induced liver injury (DILI), drug\u2010induced autoimmune\u2010like hepatitis (DI\u2010ALH), and autoimmune hepatitis (AIH) can be challenging due to overlapping clinical characteristics. Recently, polyreactive immunoglobulin G (pIgG) was identified as a novel biomarker in AIH. This retrospective study aimed to evaluate the diagnostic accuracy of pIgG to distinguish between AIH, DI\u2010ALH, and DILI and thus identify patients in need of immunosuppression.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Samples from 120 patients (AIH\u2009=\u200981, DI\u2010ALH\u2009=\u200916, DILI\u2009=\u200923) were compared to a control group (non\u2010AIH\u2010non\u2010DILI\u2010liver disease\u2009=\u2009596 and healthy controls\u2009=\u2009190).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n No patient in the DILI\u2010group but 98% in the AIH\u2010 and 94% in the DI\u2010ALH\u2010group received immunosuppressive treatment. PIgG levels were significantly higher in the AIH\u2010group 1.9 normalised arbitrary units (nAU) compared to DILI (1.1 nAU,\n p<\/jats:italic>\n \u2009<\u20090.001), non\u2010AIH\u2010non\u2010DILI\u2010LD (1.0 nAU,\n p<\/jats:italic>\n \u2009<\u20090.001) and healthy controls (0.27 nAU,\n p<\/jats:italic>\n \u2009<\u20090.001). PIgG levels for DI\u2010ALH (1.7nAU) were significantly higher compared to DILI (\n p<\/jats:italic>\n \u2009=\u20090.044) and non\u2010AIH\u2010non\u2010DILI\u2010LD and healthy controls (both\n p<\/jats:italic>\n \u2009<\u20090.001). Highest AUC was seen for pIgG (0.818) compared to conventional autoantibodies. The overall accuracy of pIgG to distinguish AIH from DILI (74%) and liver injuries with and without the need for immunosuppression (73%) was like that of ANA (71%\/73%) and SMA (74%\/69%) at cut\u2010offs of \u2265\u20091\/40. PIgG was positive in up to 79% of patients with AIH that were negative for a conventional autoantibody and was positive in 90% of DI\u2010ALH cases compared to 25% in DILI that were caused by the same drugs.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n PIgG may complement current serologic tests to identify patients with liver injury in need of immunosuppressive treatment.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/liv.70571","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T05:30:49Z","timestamp":1773034249000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Elevated Polyreactive Immunoglobulin G in Immune\u2010Mediated Liver Injuries With the Need for Immunosuppressive Therapy"],"prefix":"10.1111","volume":"46","author":[{"given":"Theresa","family":"Kirchner","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School Hannover Germany"},{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George N.","family":"Dalekos","sequence":"additional","affiliation":[{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) Hamburg Germany"},{"name":"Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases General University Hospital of Larissa Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalliopi","family":"Zachou","sequence":"additional","affiliation":[{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) Hamburg Germany"},{"name":"Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases General University Hospital of Larissa Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2365-2787","authenticated-orcid":false,"given":"Mercedes","family":"Robles\u2010D\u00edaz","sequence":"additional","affiliation":[{"name":"Unidad de Gesti\u00f3n Cl\u00ednica de Aparato Digestivo, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga\u2010IBIMA, Plataforma BIONAND, CIBEREHD, Hospital Universitario Virgen de la Victoria Universidad de M\u00e1laga M\u00e1laga Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1565-0757","authenticated-orcid":false,"given":"Ra\u00fal J.","family":"Andrade","sequence":"additional","affiliation":[{"name":"Unidad de Gesti\u00f3n Cl\u00ednica de Aparato Digestivo, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga\u2010IBIMA, Plataforma BIONAND, CIBEREHD, Hospital Universitario Virgen de la Victoria Universidad de M\u00e1laga M\u00e1laga Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcial","family":"Sebode","sequence":"additional","affiliation":[{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) Hamburg Germany"},{"name":"Department of Medicine University Medical Centre Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8823-3129","authenticated-orcid":false,"given":"Ansgar","family":"Lohse","sequence":"additional","affiliation":[{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) Hamburg Germany"},{"name":"Department of Medicine University Medical Centre Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej K.","family":"Janik","sequence":"additional","affiliation":[{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) Hamburg Germany"},{"name":"Department of Hepatology, Transplantology, Internal Medicine Medical University of Warsaw Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Milkiewicz","sequence":"additional","affiliation":[{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) Hamburg Germany"},{"name":"Department of Hepatology, Transplantology, Internal Medicine Medical University of Warsaw Warsaw Poland"},{"name":"Translational Medicine Group Pomeranian Medical University Szczecin Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5027-3432","authenticated-orcid":false,"given":"Mirjam","family":"Kolev","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasser","family":"Semmo","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Bruns","sequence":"additional","affiliation":[{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) Hamburg Germany"},{"name":"Department of Medicine III University Hospital RWTH Aachen Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3070-8443","authenticated-orcid":false,"given":"Tom Jg.","family":"Gevers","sequence":"additional","affiliation":[{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) Hamburg Germany"},{"name":"Department of Gastroenterology and Hepatology Maastricht University Medical Center Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta Terziroli","family":"Beretta\u2010Piccoli","sequence":"additional","affiliation":[{"name":"Epatocentro Ticino Lugano Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2906-0480","authenticated-orcid":false,"given":"Heiner","family":"Wedemeyer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School Hannover Germany"},{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmar","family":"Jaeckel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School Hannover Germany"},{"name":"European Reference Network on Hepatological Diseases (ERN 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