Autoimmune hepatitis is an immune-mediated necrotizing inflammatory liver disease. When the patient has an acute jaundice attack and the international standardized ratio is ≥ 1.5, it is diagnosed as acute severe AIH. 50%-60% of AS-AIH progresses to acute liver failure, with poor prognosis and mortality as high as 20%. Current guidelines recommend corticosteroids for rescue, followed by emergency liver transplantation. In addition, immunosuppression may increase the risk of infection and damage the prognosis and effect of liver transplantation. Therefore, the purpose of this study is to evaluate whether corticosteroids can improve the prognosis, and determine the factors and early treatment, so as to predict the individual's response to this treatment.

This is a retrospective cohort study, including all AS-AIH patients admitted to the tertiary center in the United States 13 from June 2002 to June 2006. The main outcome was death or liver transplantation within 90 days after admission. Kaplan-Meier and Cox regression methods are used for data statistical analysis.

Of the 242 consecutive patients, 203 received corticosteroid therapy. The overall 90-day transplant-free survival rate was 665,438 0.6%. Corticosteroids can reduce the risk of adverse consequences, but the failure rate of this treatment is 30.5%. An internally verified nomogram consists of elderly people, MELD, encephalopathy and ascites at the beginning of corticosteroids, which accurately predicts the response. In responders, MELD improved significantly from day 3 to day 14, but remained unchanged in nonresponders. The MELD critical value of 25 on the 7th day was the best univariate predictor of the reaction. Long-term use of corticosteroids does not increase the overall risk of infection.

This study confirmed that elderly patients with high MELD, encephalopathy or ascites at the beginning and during steroid therapy are unlikely to show good therapeutic response, so these patients should avoid prolonged treatment, especially if they are transplant candidates.

Original source:

Louis Taylor. Severe autoimmune hepatitis as an early predictor of corticosteroid response: a nationwide multicenter study. Food pharmacology therapeutics. 2022

Author: xuyihan