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Multicenter Study
. 2022 Jul;56(1):131-143.
doi: 10.1111/apt.16926. Epub 2022 Apr 25.

Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study

Luis Téllez  1 , Eugenia Sánchez Rodríguez  1 , Enrique Rodríguez de Santiago  1 , Laura Llovet  2 , Ana Gómez-Outomuro  3 , Fernando Díaz-Fontenla  4 , Patricia Álvarez López  5 , María García-Eliz  6 , Carla Amaral  7 , Yolanda Sánchez-Torrijos  8 , José Ignacio Fortea  9 , Carlos Ferre-Aracil  10 , Manuel Rodríguez-Perálvarez  11 , Marta Abadía  12 , Judith Gómez-Camarero  13 , Antonio Olveira  12 , José Luis Calleja  10 , Javier Crespo  8 , Manuel Romero, Manuel Hernández-Guerra  7 , Marina Berenguer  6 , Mar Riveiro-Barciela  5 , Magdalena Salcedo  4 , Manuel Rodríguez  3 , María Carlota Londoño  2 , Agustín Albillos  1
Affiliations
Multicenter Study

Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study

Luis Téllez et al. Aliment Pharmacol Ther. 2022 Jul.

Abstract
in English, Somali

Background and aims: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Corticosteroids in acute‐severe autoimmune hepatits.

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Figures

FIGURE 1
FIGURE 1
Patient recruitment flowchart. AS‐AIH, acute severe autoimmune hepatitis; LT, Liver transplantation
FIGURE 2
FIGURE 2
Nomogram to estimate the risk of treatment failure. (A) Nomogram at the initiation of treatment; (B) nomogram at day 7 of treatment. To use the nomogram, we first draw a line from each parameter value to the score axis for the score. The points for all the parameters are then added. Finally, a line from the total score points axis is drawn to the lower line of the nomogram to obtain the predicted 90‐day transplant‐free survival. MELD: Model for end‐stage liver disease
FIGURE 3
FIGURE 3
Calibration of a prognostic model. (A) Calibration plots of the nomogram at the initiation of treatment predicting 90‐day transplant‐free survival. (B–E) calibration plots of the nomogram at the initiation of treatment for predicting the corticosteroid therapy response at different time points: (B) 7 days of treatment; (C) 14 days of treatment; (D) 30 days after admission; (E) 90 days after admission. We plotted smoothed pseudovalues with point‐wise 95% confidence intervals against predicted event probabilities. The straight line is the line of identity, denoting perfect calibration
FIGURE 4
FIGURE 4
Changes in MELD scores during corticosteroid therapy. MELD, model for end‐stage liver disease. (A) Corticosteroid responders; (B) Corticosteroid non‐responders
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Comment in

References

    1. Manns MP, Czaja AJ, Gorham JD, Krawitt EL, Mieli‐Vergani G, Vergani D, et al. Diagnosis and management of autoimmune hepatitis. Hepatology. 2010;51(6):2193–213. 10.1002/hep.23584 - DOI - PubMed
    1. European Association for the Study of the Liver . EASL clinical practice guidelines: autoimmune hepatitis. J Hepatol. 2015;63(4):971–1004. 10.1016/j.jhep.2015.06.030 - DOI - PubMed
    1. Lohse AW, Mieli‐Vergani G. Autoimmune hepatitis. J Hepatol. 2011. Jul;55(1):171–82. 10.1016/j.jhep.2010.12.012 - DOI - PubMed
    1. Takahashi H, Zeniya M. Acute presentation of autoimmune hepatitis: does it exist? A published work review. Hepatol Res. 2011. Jun;41(6):498–504. 10.1111/j.1872-034X.2011.00808.x - DOI - PubMed
    1. Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, et al. Diagnosis and Management of Autoimmune Hepatitis in adults and children: 2019 practice guidance and guidelines from the American Association for the Study of Liver Diseases. Hepatology. 2020;72(2):671–722. 10.1002/hep.31065 - DOI - PubMed

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