Abstract | AIM: To determine factors predicting relapse and poor outcome in patients with type I autoimmune hepatitis (AIH). METHODS: Patients with AIH were retrospectively recruited. Definitions-remission: AST/ALT < 2 ULN; relapse: AST/ALT > or = 2 ULN; poor outcome: cirrhosis complications, transplantation (OLTx), and death; abnormal transaminases: AST/ALT > ULN but within the remission range; abnormal transaminases index (ATI): number of occasions AST/ALT abnormal/years of remission. Liver biopsies were assessed by Ishak system, and additional score given for portal and parenchymal plasma cells. Data are presented as median (range). RESULTS: Seventy-one patients were identified. Twenty (28%) had cirrhosis at presentation, 14 (20%) developed it during follow-up of 52 months (18-336). Of the 14, four had histological confirmation, and the remainder had clinical/radiological evidence of cirrhosis. Factors independently associated with cirrhosis development were inability to have consistently normal transaminases during remission, OR 19.3 (95% CI 2.2-40), p = 0.002. Treatment was discontinued in 40/69 patients of whom 30 (75%) relapsed within 2 months (1-23), culminating in one death. Factors independently associated with relapse were: time to initial remission, OR 5.5, 95% CI 1.3-22, p = 0.01; failure to have consistently normal transaminases during remission OR 11.8, 95% CI 1.3-100, p = 0.02; and portal plasma cell score (PPCS) OR 10.6 (95% CI 1.0-107), p = 0.04. Time to remission > or = 5 months, PPCS > or = 3 and ATI > or = 2 was associated with > 90% probability of relapse (PPV 100%). Fifteen percent had a poor outcome. Independent predictors of poor outcome were: globulins at onset OR 3.4 (95% CI 1.1-10.1), p = 0.02 and cirrhosis development, OR 23 (95% CI 1.7-307), p = 0. CONCLUSIONS: Seventy percent of patients with AIH relapse upon drug cessation. Time to remission > or = 5 months, ATI > or = 2 and PPCS > or = 3 were associated with > 90% probability of relapse. Factors predicting poor outcome were globulins at onset and cirrhosis development.
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Authors | Sumita Verma, Basuki Gunuwan, Michel Mendler, Sugantha Govindrajan, Allan Redeker |
Journal | The American journal of gastroenterology
(Am J Gastroenterol)
Vol. 99
Issue 8
Pg. 1510-6
(Aug 2004)
ISSN: 0002-9270 [Print] United States |
PMID | 15307869
(Publication Type: Journal Article)
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Copyright | Copyright 2004 American College of Gastroenterology |
Chemical References |
- Serum Globulins
- Aspartate Aminotransferases
- Alanine Transaminase
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Topics |
- Adolescent
- Adult
- Aged
- Alanine Transaminase
(blood)
- Aspartate Aminotransferases
(blood)
- Biopsy
- Child
- Female
- Hepatitis, Autoimmune
(complications, diagnosis, pathology, therapy)
- Humans
- Liver
(pathology)
- Liver Cirrhosis
(complications)
- Logistic Models
- Male
- Middle Aged
- Plasma Cells
(pathology)
- Prognosis
- Recurrence
- Remission Induction
- Retrospective Studies
- Risk Factors
- Serum Globulins
(analysis)
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