Prognosis of acute severe autoimmune hepatitis (AS-AIH): the role of corticosteroids in modifying outcome.

Abstract

BACKGROUND & AIMS:

No standardised definition exists for acute, severe AIH (AS-AIH). However, rapid identification of AS-AIH and early corticosteroid therapy may prevent the need for liver transplantation (LT). We set out to determine the clinical outcomes of patients with AS-AIH presenting to our institution with particular focus on the role of corticosteroids.

METHODS:

Retrospective analysis of a prospectively collated database identified patients presenting with AS-AIH from 1999 to 2009. We defined AS-AIH as an acute presentation with an INR of ⩾1.5 at any time without histological evidence of cirrhosis.

RESULTS:

32 patients were identified with AS-AIH. Among the 32 AS-AIH patients 23 were treated with corticosteroids of whom 10 (48%) required LT, whilst all 9 untreated patients required LT (p = 0.01). Untreated patients demonstrated higher MELD scores at presentation (34 vs. 28 p = 0.01) and a non-significant decrease in episodes of sepsis but no difference in sepsis or mortality was observed between untreated or treated patients (11% vs. 26% p = 0.6 and 22% vs. 17% p = 0.99 respectively). Among treated patients, no difference in MELD scores was observed between responders or failures. Despite 59% undergoing LT, six deaths (19%) occurred.

CONCLUSION:

In a well characterised cohort of patients with AS-AIH, almost 60% required LT and 20% died. There was no difference in prognostic scores between steroid responders and failures and steroid exposure did not appear to jeopardise survival. Patients with AS-AIH should be considered for a trial of corticosteroids expediently whilst a thorough search for sepsis and assessment for LT should occur if clinical deterioration or encephalopathy develops.

• Authors: Andrew D Yeoman, Rachel H Westbrook, Yoh Zen, William Bernal, Thawab Al-Chalabi, Julia A Wendon, John G O'Grady, Michael A Heneghan
• Journal: Journal of hepatology (J Hepatol) Vol. 61 Issue 4 Pg. 876-82 (Oct 2014) ISSN: 1600-0641 [Electronic] Netherlands
• PMID: 24842305 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Chemical References

• Adrenal Cortex Hormones
• Glucocorticoids
• Immunologic Factors

Topics

• Acute Disease
• Adrenal Cortex Hormones (administration & dosage, adverse effects)
• Adult
• Early Medical Intervention (methods)
• Female
• Glucocorticoids (administration & dosage, adverse effects)
• Hepatic Encephalopathy (etiology, prevention & control)
• Hepatitis, Autoimmune (complications, diagnosis, drug therapy, mortality, physiopathology)
• Humans
• Immunologic Factors (administration & dosage, adverse effects)
• Liver Function Tests (methods)
• Liver Transplantation (statistics & numerical data)
• Male
• Prognosis
• Retrospective Studies
• Sepsis (etiology, prevention & control)
• Serologic Tests (methods)
• Severity of Illness Index
• United Kingdom (epidemiology)