Role of serum igg as a prognostic marker in chronic liver disease in a tertiary care centre

Decompensated liver cirrhosis induces functional immunosuppression, characterized by an increased susceptibility to infections and a failure to mount protective immune responses to prophylactic vaccinations. The role of Serum IgG levels, a cost-effective and readily available test, in predicting outcomes in cirrhosis and assessing humoral immune capacity, has been inadequately studied, with limited research available on this aspect. 100 consecutive cirrhotic patients admitted to our hospital between April 2022 to December 2023, encompassing compensated, decompensated cirrhosis and acute-on-chronic liver disease cases were included in the study.. Serum IgG levels were measured and patients were prospectively followed for 12 months, and the correlation between serum IgG levels and prognostic outcomes was assessed.Statistical analysis was conducted using SPSS version 20. Mean serum IgG was 1.26-fold higher than normal but did not correlate with the severity of liver disease according to MELD/CHILD score. Hypergammaglobulinemia was present in 36.58% of decompensated cirrhosis, associated with lower mortality. However, serum IgG elevation was found in 67.7% of decompensated cirrhosis, and the two markers did not correlate with each other. Elevated IgG levels were universal in compensated cirrhosis, and mean IgG levels were lower in acute on chronic liver disease mortality cases, suggesting a correlation with the capacity to mount an immune response in compensated disease. Elevated IgG levels were associatedwith lower 90-day mortality, although not statistically significant. Cirrhosis with elevated IgG had a lower incidence of variceal bleeding, but further studies are needed regarding its correlation with portal hypertension. Contrary to expectations, elevated IgG patients did not have a lower incidence of infective complications like pneumonia, UTI, cellulitis, or spontaneous bacterial peritonitis (SBP), challenging the conventional correlation of IgG levels with protective immune response. Conclusion: Serum IgG levels emerge as a practical tool for predicting outcomes and assessing humoral immune capacity in cirrhosis. The study highlights the complex immune dysfunctions in cirrhosis, revealing the paradox of hypergammag lobulinemia coexisting with functional immunosuppression. Elevated IgG levels, especially in the presence of hypergammaglobulinemia, may confer a survival benefit in decompensated cirrhosis, challenging existing paradigms in cirrhosis management and offering insights for risk stratification and therapeutic considerations.