Department of Gastroenterology and Hepatology, University Clinic of Essen, Essen 45147, Germany.
Institute of Transfusion Medicine, University Clinic of Essen, Essen 45147, Germany.
World J Gastroenterol. 2018 Apr 7;24(13):1410-1418. doi: 10.3748/wjg.v24.i13.1410.
To investigate potential triggering factors leading to acute liver failure (ALF) as the initial presentation of autoimmune hepatitis (AIH).
A total of 565 patients treated at our Department between 2005 and 2017 for histologically-proven AIH were retrospectively analyzed. However, 52 patients (9.2%) fulfilled the criteria for ALF defined by the "American Association for the Study of the Liver (AASLD)". According to this definition, patients with "acute-on-chronic" or "acute-on-cirrhosis" liver failure were excluded. Following parameters with focus on potential triggering factors were evaluated: Patients' demographics, causation of liver failure, laboratory data (liver enzymes, MELD-score, autoimmune markers, virus serology), liver histology, immunosuppressive regime, and finally, outcome of our patients.
The majority of patients with ALF were female (84.6%) and mean age was 43.6 ± 14.9 years. Interestingly, none of the patients with ALF was positive for anti-liver kidney microsomal antibody (LKM). We could identify potential triggering factors in 26/52 (50.0%) of previously healthy patients presenting ALF as their first manifestation of AIH. These were drug-induced ALF (57.7%), virus-induced ALF (30.8%), and preceding surgery in general anesthesia (11.5%), respectively. Unfortunately, 6 out of 52 patients (11.5%) did not survive ALF and 3 patients (5.7%) underwent liver transplantation (LT). Comparing data of survivors and patients with non-recovery following treatment, MELD-score ( < 0.001), age ( < 0.05), creatinine ( < 0.01), and finally, ALT-values ( < 0.05) reached statistical significance.
Drugs, viral infections, and previous surgery may trigger ALF as the initial presentation of AIH. Advanced age and high MELD-score were associated with lethal outcome.
探讨导致急性肝衰竭（ALF）作为自身免疫性肝炎（AIH）初始表现的潜在触发因素。
回顾性分析 2005 年至 2017 年在我科接受组织学证实的 AIH 治疗的 565 例患者。然而，52 例（9.2%）符合美国肝病研究协会（AASLD）定义的 ALF 标准。根据这一定义，排除了“慢加急性”或“急性肝硬化”肝衰竭的患者。评估了以下重点为潜在触发因素的参数：患者的人口统计学资料、肝衰竭的病因、实验室数据（肝酶、MELD 评分、自身免疫标志物、病毒血清学）、肝组织学、免疫抑制方案以及患者的最终结局。
大多数 ALF 患者为女性（84.6%），平均年龄为 43.6±14.9 岁。有趣的是，无 1 例 ALF 患者抗肝-肾微粒体抗体（LKM）阳性。我们在 52 例（50.0%）先前健康的患者中发现了潜在的触发因素，这些患者以 ALF 为其 AIH 的首发表现。这些触发因素分别为药物诱导的 ALF（57.7%）、病毒诱导的 ALF（30.8%）和全麻下的先前手术（11.5%）。不幸的是，52 例患者中有 6 例（11.5%）未从 ALF 中存活，3 例（5.7%）接受了肝移植（LT）。比较存活患者和经治疗未恢复患者的数据，MELD 评分（<0.001）、年龄（<0.05）、肌酐（<0.01）和最终 ALT 值（<0.05）均具有统计学意义。
药物、病毒感染和先前的手术可能会引发 ALF，作为 AIH 的首发表现。高龄和高 MELD 评分与致死结局相关。
