Outcomes of patients with acute severe autoimmune hepatitis: Predictors of non-response to corticosteroids and need for liver transplantation.

IF 5.8 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
United European Gastroenterology Journal Pub Date : 2024-09-01 Epub Date: 2024-05-11 DOI:10.1002/ueg2.12582
Ahad Eshraghian, Alireza Taghavi, Saman Nikeghbalian
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引用次数: 0

Abstract

Background and aims: Acute severe autoimmune hepatitis (AS-AIH) is an evolving concept and the outcomes and optimal treatment have been less studied. In this study, we aimed to investigate the outcomes of patients with AS-AIH and predictors of non-response to corticosteroid therapy and need for liver transplantation.

Methods: In a retrospective cohort, we included patients with AS-AIH admitted to our liver center. We defined AS-AIH based on the international autoimmune hepatitis group score as acute presentation of AIH with an international normalized ratio (INR) ≥ 1.5 and without liver cirrhosis and hepatic encephalopathy. All patients received high dose corticosteroid therapy. Treatment response was defined as liver transplant free survival at 4 months after presentation. Factors associated with response to corticosteroids and survival of patients were studied.

Results: In total, 61 patients with AS-AIH were included. Forty-seven patients responded to corticosteroid therapy. In the multivariate regression model, baseline INR (odds ratio [OR]: 0.184; 95% confidence interval [CI]: 0.048-0.699; p = 0.013) and delayed versus early initiation of corticosteroid (after vs. before 5 days of presentation) (OR: 0.189; 95% CI: 0.039-0.919; p = 0.039) were independent predictors of clinical non-response to corticosteroid therapy. In the multivariable Cox regression model, baseline INR level (hazard ratio [HR]: 2.542; 95% CI: 1.188-5.440; p = 0.016) and delayed initiation of corticosteroids (HR: 3.578; 95% CI: 1.084-11.812; p = 0.036) were independent predictors of liver transplant free survival at 6 months after diagnosis.

Conclusion: Delayed initiation of corticosteroid therapy might be predictive of clinical non-response to medical therapy and need for liver transplantation in patients with AS-AIH.

急性重症自身免疫性肝炎患者的预后:对皮质类固醇无反应和需要肝移植的预测因素。
背景和目的:急性重症自身免疫性肝炎(AS-AIH)是一个不断发展的概念,对其预后和最佳治疗方法的研究较少。在这项研究中,我们旨在调查急性重症自身免疫性肝炎患者的预后以及对皮质类固醇治疗无反应和需要肝移植的预测因素:在一项回顾性队列中,我们纳入了肝病中心收治的 AS-AIH 患者。我们根据国际自身免疫性肝炎组评分将AS-AIH定义为国际正常化比值(INR)≥1.5且无肝硬化和肝性脑病的急性AIH。所有患者均接受大剂量皮质类固醇治疗。治疗反应的定义是发病 4 个月后无肝移植存活。研究了与皮质类固醇治疗反应和患者存活率相关的因素:结果:共纳入 61 例 AS-AIH 患者。47名患者对皮质类固醇治疗有反应。在多变量回归模型中,基线 INR(几率比 [OR]:0.184; 95% 置信区间 [CI]:0.048-0.699;p = 0.013)和皮质类固醇开始时间的延迟与提前(发病 5 天后与发病 5 天前)(OR:0.189;95% CI:0.039-0.919;p = 0.039)是皮质类固醇治疗临床无应答的独立预测因素。在多变量 Cox 回归模型中,基线 INR 水平(OR:2.542;95% CI:1.188-5.440;p = 0.016)和延迟开始皮质类固醇治疗(OR:3.578;95% CI:1.084-11.812;p = 0.036)是确诊后 6 个月无肝移植存活的独立预测因素:结论:延迟开始皮质类固醇治疗可能是AS-AIH患者对药物治疗无临床反应和需要进行肝移植的预测因素。
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来源期刊
United European Gastroenterology Journal
United European Gastroenterology Journal GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
10.50
自引率
13.30%
发文量
147
期刊介绍: United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
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