Noninvasive Prediction of Outcomes in Autoimmune Hepatitis-Related Cirrhosis

Abstract

The value of noninvasive tools in the diagnosis of autoimmune hepatitis (AIH)-related cirrhosis and the prediction of clinical outcomes is largely unknown. We sought to evaluate (1) the utility of liver stiffness measurement (LSM) in the diagnosis of cirrhosis and (2) the performance of the Sixth Baveno Consensus on Portal Hypertension (Baveno VI), expanded Baveno VI, and the ANTICIPATE models in predicting the absence of varices needing treatment (VNT). A multicenter cohort of 132 patients with AIH-related cirrhosis was retrospectively analyzed. LSM and endoscopies performed at the time of cirrhosis diagnosis were recorded. Most of the patients were female (66%), with a median age of 54 years. Only 33%-49% of patients had a LSM above the cutoff points described for the diagnosis of AIH-related cirrhosis (12.5, 14, and 16 kPa). Patients with portal hypertension (PHT) had significantly higher LSM than those without PHT (15.7 vs. 11.7 kPa; P = 0.001), but 39%-52% of patients with PHT still had LSM below these limits. The time since AIH diagnosis negatively correlated with LSM, with longer time being significantly associated with a lower proportion of patients with LSM above these cutoffs. VNT was present in 12 endoscopies. The use of the Baveno VI, expanded Baveno VI criteria, and the ANTICIPATE model would have saved 46%-63% of endoscopies, but the latter underpredicted the risk of VNT. Conclusions: LSM cutoff points do not have a good discriminative capacity for the diagnosis of AIH-related cirrhosis, especially long-term after treatment initiation. Noninvasive tools are helpful to triage patients for endoscopy.

FIG. 1

Flowchart of the patients included in the study. Abbreviation: EV, esophageal varices.

FIG. 2

Impact of time between the initiation of immunosuppressive treatment and LSM on the ability of LSM to detect cirrhosis in patients with AIH. (A) Correlation between time (in months) and LSM (kPa). Bivariate correlation was analyzed using the Spearman rank‐order correlation test. (B) Proportion of patients with cirrhosis and LSM ≥ 12.5 kPa, 14 kPa, and 16 kPa according to time after treatment initiation (divided into four periods: ≤12 months, 12‐36 months, 36‐60 months, and ≥60 months). (C) Same as (B) but analyzing only patients with portal hypertension.

FIG. 3

Association between VCTE values and platelet count and the risk of VNT in patients with cirrhosis related to AIH. These exploratory plots were constructed with non‐parametric local regression (locally weighted least squares).

FIG. 4

Performance (in terms of calibration) of the original ANTICIPATE model and the ANTICIPATE‐PBC model in predicting VNT. (A) Calibration plot of the original ANTICIPATE model. This model underpredicted the risk of VNT in the segment of patients with a risk of between 5% and 20%. (B) Calibration plot of the ANTICIPATE‐PBC model, which shows excellent agreement between the predicted and observed probabilities of VNT. The bars over the x‐axis show the distribution of the patients according to predicted risks. Z‐value represents the Spiegelhalter calibration^{( 20 )} with its P value. The closer the value of the Z‐statistic to zero, and the higher its P value, the better the calibration of the model.