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Factors predicting relapse and poor outcome in type I autoimmune hepatitis: role of cirrhosis development, patterns of transaminases during remission and plasma cell activity in the liver biopsy.

AbstractAIM:
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.
AuthorsSumita Verma, Basuki Gunuwan, Michel Mendler, Sugantha Govindrajan, Allan Redeker
JournalThe American journal of gastroenterology (Am J Gastroenterol) Vol. 99 Issue 8 Pg. 1510-6 (Aug 2004) ISSN: 0002-9270 [Print] United States
PMID15307869 (Publication Type: Journal Article)
CopyrightCopyright 2004 American College of Gastroenterology
Chemical References
  • Serum Globulins
  • Aspartate Aminotransferases
  • Alanine Transaminase
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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