Lupus hepatitis as the primary cause: a retrospective analysis of liver biopsy in systemic lupus erythematosus with unexplained liver function abnormalities from two centers in Southern China.

Objective: To assess the clinical utility and safety of liver biopsy in diagnosing systemic lupus erythematosus (SLE) patients with unexplained liver function abnormalities. Additionally, this study aims to deeply explore the etiological spectrum of such SLE cases.

Methods: A retrospective analysis was conducted on the pathological results and clinical characteristics of SLE patients who underwent liver biopsy due to liver function abnormalities in the First Affiliated Hospital of Guangxi Medical University and the Affiliated Hospital of Guilin Medical College from June 2017 to December 2023.

Results: A total of 73 SLE patients who underwent liver biopsy were included in the study. Among 73 patients, 71 (97.3%) achieved definitive diagnoses. Etiological distribution included: lupus hepatitis (50 cases, 68.5%), drug-induced liver injury (6 cases, 8.2%), autoimmune hepatitis (AIH, 5 cases, 6.8%), viral hepatitis (4 cases, 5.5%), fatty liver (3 cases, 4.1%), and 1 case each (1.4%) of primary biliary cirrhosis (PBC), AIH-PBC overlap syndrome, and glycogen storage disease. Two cases (2.7%) remained undetermined.

Conclusion: Based on the histological analysis, lupus liver damage emerged as the most prevalent cause of unexplained abnormal liver function test results in SLE patients. Both autoimmune hepatitis and lupus hepatitis have the potential to progress with fibrotic hyperplasia, ultimately leading to cirrhosis. Liver biopsy demonstrated its safety and significant value in the etiological diagnosis of SLE patients with unexplained abnormal liver function. Clinical characteristics can offer valuable clues for etiological speculation, and pathological examination remains indispensable for accurate disease diagnosis and progression assessment.