Autoimmune Hepatitis with Acute Presentation: Clinical, Biochemical, and Histological Features of 126 Patients.

IF 2.7 4区 医学 Q2 Medicine Canadian Journal of Gastroenterology and Hepatology Pub Date : 2022-09-26 eCollection Date: 2022-01-01 DOI:10.1155/2022/6470847
Álvaro Urzúa, Carolina Pizarro, Abraham Gajardo, Rafael Poniachik, Claudia Pavez, Máximo Cattaneo, Javier Brahm, Laura Carreño, Jaime Poniachik
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引用次数: 1

Abstract

Introduction: Autoimmune hepatitis (AIH) is a chronic liver disease with a relevant inflammatory component and an unknown etiology. Evidence for clinical characteristics and risk factors in large cohorts of patients with acute AIH (AAIH) is lacking. We clinically characterized patients with AAIH, the prevalence of a combined adverse outcome (death or liver transplantation (LT)), and its risk factors.

Methods: A retrospective study of adult patients diagnosed with AAIH at three centers (Santiago, Chile; 2000-2018) was conducted. Clinical and laboratory characteristics were obtained. A liver biopsy was performed for all patients. Descriptive statistics and logistic regression models were used.

Results: A total of 126 patients were admitted; 77% were female, 33 (26.2%) had a severe presentation, and 14 (11.1%) had a fulminant presentation. Overall, 24 patients (19.0%) lacked typical autoantibodies, and 26.2% had immunoglobulin G levels in the normal range. The most frequent histological findings were plasma cells (86.5%), interface hepatitis (81.7%), and chronic hepatitis (81.0%). Rosettes were uncommon (35.6%). Advanced fibrosis was present in 27% of patients. Combined adverse outcomes occurred in 7.9% of cases, all fulminant with histological cholestasis. Alkaline phosphatase, bilirubin, and prothrombin less than 50% were independent risk factors for in-hospital death or LT (p value <0.05). Although corticosteroid treatment was associated with better outcomes (OR 0.095, p value = 0.013), more severe patients were less likely to receive this therapy. Discussion. In this large cohort of patients with AAIH, clinical characteristics differ from those reported in patients with chronic AIH. Fulminant hepatitis, histological cholestasis, alkaline phosphatase, bilirubin, and prothrombin were associated with death/LT.

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急性表现的自身免疫性肝炎:126例患者的临床、生化和组织学特征
自身免疫性肝炎(AIH)是一种慢性肝脏疾病,具有相关的炎症成分和未知的病因。大量急性AIH (AAIH)患者的临床特征和危险因素缺乏证据。我们对AAIH患者的临床特征、综合不良结局(死亡或肝移植)的发生率及其危险因素进行了分析。方法:对三个中心诊断为AAIH的成年患者(智利圣地亚哥;2000-2018年)。获得临床和实验室特征。所有患者均行肝活检。采用描述性统计和逻辑回归模型。结果:共收治126例患者;77%为女性,33例(26.2%)有严重表现,14例(11.1%)有暴发性表现。总体而言,24例患者(19.0%)缺乏典型的自身抗体,26.2%的患者免疫球蛋白G水平在正常范围内。最常见的组织学表现为浆细胞(86.5%)、界面肝炎(81.7%)和慢性肝炎(81.0%)。莲座不常见(35.6%)。27%的患者存在晚期纤维化。7.9%的病例发生了联合不良后果,所有病例均伴有组织学胆汁淤积。碱性磷酸酶、胆红素和凝血酶原低于50%是院内死亡或LT的独立危险因素(p值p值= 0.013),重症患者接受此治疗的可能性较小。讨论。在这个AAIH患者的大队列中,临床特征与慢性AIH患者的报道不同。暴发性肝炎、组织学胆汁淤积、碱性磷酸酶、胆红素和凝血酶原与死亡/LT相关。
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来源期刊
CiteScore
4.80
自引率
0.00%
发文量
0
审稿时长
37 weeks
期刊介绍: Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
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