Background: Serum immunoglobulin G (IgG) levels are central to the diagnosis and monitoring of autoimmune hepatitis (AIH), yet the clinical implications of markedly elevated IgG remain incompletely characterized. We examined whether higher maximal serum IgG levels are associated with a biochemical phenotype of more severe hepatic injury, impaired hepatic synthetic function, and adverse clinical outcomes in patients with AIH. Methods: We conducted a retrospective cohort study of 80 adults with AIH treated at Sheba Medical Center. Patients were categorized into low, intermediate, and high IgG strata according to tertiles of maximal documented serum IgG. Demographic characteristics, comorbidities, treatments, admission laboratory values, hepatic synthetic function markers, and mortality outcomes were compared across strata. Primary outcomes were serum albumin, international normalized ratio (INR), hypoalbuminemia and the INR-to-albumin ratio. Secondary outcomes included hepatocellular and cholestatic pathophysiology surrogate markers, hospital length of stay, all-cause mortality during follow-up, and one- and five-year mortality. Results: Among 80 patients, maximal IgG differed significantly across strata (overall median, 2030 [IQR, 1545–2802.5]; low, 1320 [1105–1520]; intermediate, 2040 [1845–2215]; and high, 3310 [2827.5–3747.5]; p < 0.001). Compared with the low-IgG group, the high-IgG group had more frequent hypoalbuminemia (53.8% vs. 11.1%; p = 0.002), more frequent elevated INR values (34.6% vs. 7.4%; p = 0.035), and a higher INR-to-albumin ratio (median, 0.45 vs. 0.30; p < 0.001). Mortality did not differ significantly across IgG strata, including all-cause mortality during follow-up (15.4%, 14.8%, and 14.8%; p = 1.00), one-year mortality (p = 0.49), and five-year mortality (p = 0.72). After adjustment for age, recorded cirrhosis, ALT and corticosteroid exposure, each 1000 mg/dL increase in maximal IgG was associated with 0.248 g/dL lower albumin, 9.5% higher INR and an 18.5% higher INR-to-albumin ratio (all p < 0.001). Conclusions: Higher serum IgG levels in AIH patients were associated with impaired hepatic synthetic function, reflected by lower albumin, higher INR, and a higher INR-to-albumin ratio, without a corresponding increase in short- or intermediate-term mortality in this cohort. Markedly elevated IgG may help identify patients who warrant closer assessment of their synthetic hepatic reserve.

Background. The use of vasoconstricting agents is an important part of the armament used by modern medicine in the treatment of patients suffering from septic shock. Nevertheless, their administration is associated with different severities of limb ischemia. The aim of the current study was to quantify this adverse outcome of treatment. Methods. This retrospective study analyzed patients suffering from septic shock, who were hospitalized in a tertiary medical center. Results. Out of 7,160 patients suffering from septic shock that were hospitalized in our medical center over a period of 13 years, 4,468 were eligible for analysis. Among them 2,181 received vasopressor treatment, and 2,287 did not. While the rate of in-hospital mortality was higher in the vasopressor group (32.3% vs. 27.4%; p < 0.001), as was the incidence of acute kidney injury (28.1% vs. 18.4%; p < 0.001) and the portion of patients with in-hospital length of stay > 7 days (65.4% vs. 61.5%; p = 0.007), there was no significant difference between the rate of in-hospital amputations between the two study groups (0.8% vs. 1.1%; p = 0.44). Independent risk factors for amputations include older age and preexisting diagnosis of peripheral vascular disease.. Conclusion. The use of vasopressors as part of the treatment for patients suffering from septic shock does not appear to increase the risk of resultant amputations. Nevertheless, advanced age and pre-morbid peripheral vascular disease are associated with a higher likelihood of amputation.