RT Journal Article
T1 Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study.
A1 Tellez, Luis
A1 Sanchez Rodriguez, Eugenia
A1 Rodriguez de Santiago, Enrique
A1 Llovet, Laura
A1 Gomez-Outomuro, Ana
A1 Diaz-Fontenla, Fernando
A1 Alvarez Lopez, Patricia
A1 Garcia-Eliz, Maria
A1 Amaral, Carla
A1 Sanchez-Torrijos, Yolanda
A1 Fortea, Jose Ignacio
A1 Ferre-Aracil, Carlos
A1 Rodriguez-Peralvarez, Manuel
A1 Abadia, Marta
A1 Gomez-Camarero, Judith
A1 Olveira, Antonio
A1 Calleja, Jose Luis
A1 Crespo, Javier
A1 Romero, Manuel
A1 Hernandez-Guerra, Manuel
A1 Berenguer, Marina
A1 Riveiro-Barciela, Mar
A1 Salcedo, Magdalena
A1 Rodriguez, Manuel
A1 Londoño, Maria Carlota
A1 Albillos, Agustin
K1 Acute disease
K1 Adolescent
K1 Adrenal cortex hormones
K1 Ascites
AB 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.
PB Wiley-Blackwell Publishing
YR 2022
FD 2022-04-02
LK http://hdl.handle.net/10668/19913
UL http://hdl.handle.net/10668/19913
LA en
NO Téllez L, Sánchez Rodríguez E, Rodríguez de Santiago E, Llovet L, Gómez-Outomuro A, Díaz-Fontenla F, et al. Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study. Aliment Pharmacol Ther. 2022 Jul;56(1):131-143
DS RISalud
RD Apr 18, 2025