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. 2025 Apr 8:S1542-3565(25)00249-6.
doi: 10.1016/j.cgh.2025.02.010. Online ahead of print.

Hepatic Encephalopathy and MELD-Na Predict Treatment Benefit in Autoimmune Hepatitis-related Decompensated Cirrhosis

Pinelopi Arvaniti  1 , Sergio Rodríguez-Tajes  2 , Marlene Padilla  3 , Ignasi Olivas  2 , Ezequiel Mauro  4 , Cautar El Maimouni  4 , Ellina Lytvyak  5 , Xavier Verhelst  6 , Bastian Engel  7 , Richard Taubert  7 , Sara Lorente-Pérez  8 , Isabel Conde  9 , Mar Riveiro-Barciela  10 , Juan-Carlos Ruiz-Cobo  10 , Carmen Álvarez-Navascués  11 , Magdalena Salcedo  12 , Judith Gómez  13 , Maciej K Janik  14 , Beatriz Mateos  15 , Cumali Efe  16 , Alessandro Granito  17 , Elton Dajti  18 , Francesco Azzaroli  18 , Diana Horta  19 , Carmen Vila  20 , Inmaculada Castello  21 , Indhira Pérez-Medrano  22 , Ana Arencibia  23 , Alessio Gerussi  24 , Tony Bruns  25 , Francesca Colaprieto  26 , Ana Lleo  26 , Natalie Van den Ende  27 , Jef Verbeek  27 , Álvaro Díaz-González  28 , Rosa Ma Morillas  29 , Maria Torner-Simó  29 , Vanesa Bernal  30 , Eva-Maria Fernández  30 , Tom J G Gevers  31 , Benedetta Terziroli Beretta-Piccoli  32 , Elena Gómez  33 , Paqui Cuenca  34 , Ynte S de Boer  35 , Nanda Kerkar  36 , David N Assis  37 , Rodrigo Liberal  38 , Joost P H Drenth  39 , Michele M Tana  40 , Marcial Sebode  41 , Ida Schregel  41 , Christoph Schramm  42 , Ansgar W Lohse  41 , Aldo J Montano-Loza  5 , Kalliopi Zachou  43 , Alejandra Villamil  3 , George N Dalekos  43 , María-Carlota Londoño  44 ; International Autoimmune Hepatitis Group (IAIHG); European Reference Network on Hepatological Diseases (ENR RARE-LIVER); Spanish Registry for Autoimmune and Cholestatic Diseases (ColHai) Registry
Affiliations

Hepatic Encephalopathy and MELD-Na Predict Treatment Benefit in Autoimmune Hepatitis-related Decompensated Cirrhosis

Pinelopi Arvaniti et al. Clin Gastroenterol Hepatol. .

Abstract

Background & aims: Management of patients with autoimmune hepatitis (AIH)-related decompensated cirrhosis is challenging because of the risk of treatment-related complications and lack of clinical recommendations. We investigated the predictive factors for treatment benefit in AIH-related decompensated cirrhosis at diagnosis and developed an algorithm to guide treatment decisions in clinical practice.

Methods: This retrospective, international, multicenter study included 232 patients with histologically confirmed AIH-related decompensated cirrhosis at diagnosis. The sub-hazard ratio (SHR) of mortality was determined by competing risk analysis, considering liver transplantation (LT) as competing event. A decision tree analysis was used to develop a treatment algorithm.

Results: At diagnosis, 89% of patients had ascites, and 41% had overt hepatic encephalopathy (OHE). Treated patients (n = 214; 92%) had higher aminotransferases, bilirubin, and modified hepatic activity index. The SHR of mortality was lower in treated patients (0.438; 95% confidence interval [CI], 0.196-0.981; P = .045). Patients without OHE grade 3/4 and Model for End-Stage Liver Disease-Sodium (MELD-Na) ≤28 at diagnosis were more likely to benefit from treatment. In these patients, a decline in MELD-Na ≥11 after 4 weeks of treatment had a 100% negative predictive value for death/LT. Forty-nine percent of treated patients recompensated during follow-up. Twenty percent of patients had to discontinue treatment, 65% during the first 4 weeks, and only 4% due to infectious complications. OHE ≥grade 2 and MELD-Na at diagnosis predicted the need for treatment discontinuation.

Conclusions: Immunosuppression is beneficial in patients with AIH-related decompensated cirrhosis and active disease. OHE and MELD-Na at diagnosis, along with a decline in MELD-Na at 4 weeks of treatment, are the most important determinants of outcome and can guide treatment decisions.

Keywords: Autoimmune Hepatitis; Decompensated Cirrhosis; Liver Transplant-free Survival; Recompensation.

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