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Early Predictors of Short‐Term Prognosis in Acute and Acute Severe Autoimmune Hepatitis

Presentation of autoimmune hepatitis (AIH) can differ from nonacute to acute autoimmune hepatitis (A‐AIH) with jaundice and acute severe autoimmune hepatitis (AS‐AIH) with jaundice and coagulopathy. The aim of the study was to evaluate the short‐term prognosis of different presentations of AIH and t...

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Autores principales: Biewenga, Maaike, Inderson, Akin, Tushuizen, Maarten E., Crobach, A. Stijn L.P., van Hoek, Bart
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756691/
https://www.ncbi.nlm.nih.gov/pubmed/32997870
http://dx.doi.org/10.1002/lt.25906
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author Biewenga, Maaike
Inderson, Akin
Tushuizen, Maarten E.
Crobach, A. Stijn L.P.
van Hoek, Bart
author_facet Biewenga, Maaike
Inderson, Akin
Tushuizen, Maarten E.
Crobach, A. Stijn L.P.
van Hoek, Bart
author_sort Biewenga, Maaike
collection PubMed
description Presentation of autoimmune hepatitis (AIH) can differ from nonacute to acute autoimmune hepatitis (A‐AIH) with jaundice and acute severe autoimmune hepatitis (AS‐AIH) with jaundice and coagulopathy. The aim of the study was to evaluate the short‐term prognosis of different presentations of AIH and the influence of liver function improvement on short‐term prognosis. In this single‐center retrospective cohort study, AIH patients with repeatedly tested liver function at diagnosis and during at least 1 year of follow‐up were included. A‐AIH was defined as bilirubin >45 µmol and international normalized ratio (INR) <1.5. AS‐AIH was defined as bilirubin level >45 µmol/L and INR ≥1.5. Of the 81 included patients, 17 (21%) presented with A‐AIH, and 14 (17%) presented with AS‐AIH. After the start of immunosuppressive therapy, bilirubin, albumin, and INR normalized in 70%, 77%, and 69%, respectively, in a median of 2.6 months, 3 months, and 4 weeks, respectively, in patients with A‐AIH and AS‐AIH. Liver transplantation (LT)–free survival rate was 100% in nonacute AIH, 94% in A‐AIH, and 57% in AS‐AIH at 12 months after diagnosis. An increase of INR or bilirubin at 2 weeks was the best predictive factor for the need of LT within 12 months with a Youden’s index of 0.85. A‐AIH was present in 21%, and AS‐AIH was present in 17% of AIH patients. In the majority of patients, bilirubin, albumin, and INR normalized in the first months of treatment. Deterioration of liver function after 2 weeks of treatment should lead to rapid evaluation for LT and consideration of second‐line medication.
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spelling pubmed-77566912020-12-28 Early Predictors of Short‐Term Prognosis in Acute and Acute Severe Autoimmune Hepatitis Biewenga, Maaike Inderson, Akin Tushuizen, Maarten E. Crobach, A. Stijn L.P. van Hoek, Bart Liver Transpl Original Articles Presentation of autoimmune hepatitis (AIH) can differ from nonacute to acute autoimmune hepatitis (A‐AIH) with jaundice and acute severe autoimmune hepatitis (AS‐AIH) with jaundice and coagulopathy. The aim of the study was to evaluate the short‐term prognosis of different presentations of AIH and the influence of liver function improvement on short‐term prognosis. In this single‐center retrospective cohort study, AIH patients with repeatedly tested liver function at diagnosis and during at least 1 year of follow‐up were included. A‐AIH was defined as bilirubin >45 µmol and international normalized ratio (INR) <1.5. AS‐AIH was defined as bilirubin level >45 µmol/L and INR ≥1.5. Of the 81 included patients, 17 (21%) presented with A‐AIH, and 14 (17%) presented with AS‐AIH. After the start of immunosuppressive therapy, bilirubin, albumin, and INR normalized in 70%, 77%, and 69%, respectively, in a median of 2.6 months, 3 months, and 4 weeks, respectively, in patients with A‐AIH and AS‐AIH. Liver transplantation (LT)–free survival rate was 100% in nonacute AIH, 94% in A‐AIH, and 57% in AS‐AIH at 12 months after diagnosis. An increase of INR or bilirubin at 2 weeks was the best predictive factor for the need of LT within 12 months with a Youden’s index of 0.85. A‐AIH was present in 21%, and AS‐AIH was present in 17% of AIH patients. In the majority of patients, bilirubin, albumin, and INR normalized in the first months of treatment. Deterioration of liver function after 2 weeks of treatment should lead to rapid evaluation for LT and consideration of second‐line medication. John Wiley and Sons Inc. 2020-10-27 2020-12 /pmc/articles/PMC7756691/ /pubmed/32997870 http://dx.doi.org/10.1002/lt.25906 Text en Copyright © 2020 The Authors. Liver Transplantation published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Biewenga, Maaike
Inderson, Akin
Tushuizen, Maarten E.
Crobach, A. Stijn L.P.
van Hoek, Bart
Early Predictors of Short‐Term Prognosis in Acute and Acute Severe Autoimmune Hepatitis
title Early Predictors of Short‐Term Prognosis in Acute and Acute Severe Autoimmune Hepatitis
title_full Early Predictors of Short‐Term Prognosis in Acute and Acute Severe Autoimmune Hepatitis
title_fullStr Early Predictors of Short‐Term Prognosis in Acute and Acute Severe Autoimmune Hepatitis
title_full_unstemmed Early Predictors of Short‐Term Prognosis in Acute and Acute Severe Autoimmune Hepatitis
title_short Early Predictors of Short‐Term Prognosis in Acute and Acute Severe Autoimmune Hepatitis
title_sort early predictors of short‐term prognosis in acute and acute severe autoimmune hepatitis
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756691/
https://www.ncbi.nlm.nih.gov/pubmed/32997870
http://dx.doi.org/10.1002/lt.25906
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