%0 Journal Article
%A Tellez, Luis
%A Sanchez Rodriguez, Eugenia
%A Rodriguez de Santiago, Enrique
%A Llovet, Laura
%A Gomez-Outomuro, Ana
%A Diaz-Fontenla, Fernando
%A Alvarez Lopez, Patricia
%A Garcia-Eliz, Maria
%A Amaral, Carla
%A Sanchez-Torrijos, Yolanda
%A Fortea, Jose Ignacio
%A Ferre-Aracil, Carlos
%A Rodriguez-Peralvarez, Manuel
%A Abadia, Marta
%A Gomez-Camarero, Judith
%A Olveira, Antonio
%A Calleja, Jose Luis
%A Crespo, Javier
%A Romero, Manuel
%A Hernandez-Guerra, Manuel
%A Berenguer, Marina
%A Riveiro-Barciela, Mar
%A Salcedo, Magdalena
%A Rodriguez, Manuel
%A Londoño, Maria Carlota
%A Albillos, Agustin
%T Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study.
%D 2022
%U http://hdl.handle.net/10668/19913
%X To assess whether corticosteroids improve prognosis in patients with AS-AIH, and to identify factors at therapy initiation and during therapy predictive of the response to corticosteroids. This was a retrospective cohort study including all patients with AS-AIH admitted to 13 tertiary centres from January 2002 to January 2019. The composite primary outcome was death or liver transplantation within 90 days of admission. Kaplan-Meier and Cox regression methods were used for data analysis. Of 242 consecutive patients enrolled (mean age [SD] 49.7 [16.8] years), 203 received corticosteroids. Overall 90-day transplant-free survival was 61.6% (95% confidence interval [CI] 55.4-67.7). Corticosteroids reduced the risk of a poor outcome (adjusted hazard ratio [HR] 0.25; 95% CI 0.2-0.4), but this treatment failed in 30.5%. An internally validated nomogram composed of older age, MELD, encephalopathy and ascites at the initiation of corticosteroids accurately predicted the response (C-index 0.82; [95% CI 0.8-0.9]). In responders, MELD significantly improved from days 3 to 14 but remained unchanged in non-responders. MELD on day 7 with a cut-off of 25 (sensitivity 62.5%[95% CI: 47.0-75.8]; specificity 95.2% [95% CI: 89.9-97.8]) was the best univariate predictor of the response. Prolonging corticosteroids did not increase the overall infection risk (adjusted HR 0.75; 95% CI 0.3-2.1). Older patients with high MELD, encephalopathy or ascites at steroid therapy initiation and during treatment are unlikely to show a favourable response and so prolonged therapy in these patients, especially if they are transplantation candidates, should be avoided.
%K Acute disease
%K Adolescent
%K Adrenal cortex hormones
%K Ascites
%~