Tellez, LuisSanchez Rodriguez, EugeniaRodriguez de Santiago, EnriqueLlovet, LauraGomez-Outomuro, AnaDiaz-Fontenla, FernandoAlvarez Lopez, PatriciaGarcia-Eliz, MariaAmaral, CarlaSanchez-Torrijos, YolandaFortea, Jose IgnacioFerre-Aracil, CarlosRodriguez-Peralvarez, ManuelAbadia, MartaGomez-Camarero, JudithOlveira, AntonioCalleja, Jose LuisCrespo, JavierRomero, ManuelHernandez-Guerra, ManuelBerenguer, MarinaRiveiro-Barciela, MarSalcedo, MagdalenaRodriguez, ManuelLondoño, Maria CarlotaAlbillos, Agustin2023-05-032023-05-032022-04-02Téllez 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):131-143http://hdl.handle.net/10668/19913To 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.enAttribution-NonCommercial 4.0 Internationalhttp://creativecommons.org/licenses/by-nc/4.0/Acute diseaseAdolescentAdrenal cortex hormonesAscitesBrain diseasesHepatitis, autoimmuneHumansPrognosisRetrospective studiesSeverity of illness indexresearch article35470447open accessEncefalopatíasEstudios retrospectivosHepatitis autoinmunePronósticoÍndice de severidad de la enfermedad10.1111/apt.169261365-2036PMC9324977https://repositorio.uam.es/bitstream/10486/705454/2/early_tellez_ap%26t_2022.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9324977/pdf