Sharma Sanchit, Agarwal Samagra, Kaushal Kanav, Anand Abhinav, Gunjan Deepak, Yadav Rajni, Saraya Anoop
Department of Gastroenterology and Human Nutrition All India Institute of Medical Sciences New Delhi India.
Department of Pathology All India Institute of Medical Sciences New Delhi India.
JGH Open. 2020 Nov 13;5(1):81-90. doi: 10.1002/jgh3.12451. eCollection 2021 Jan.
Decompensated cirrhosis in autoimmune hepatitis has poor prognosis. Besides liver transplant, treatment for this entity is undefined. We explored the outcomes of autoimmune hepatitis (AIH)-related decompensated cirrhosis with active disease on treatment with steroids.
In this retrospective analysis, clinical data, laboratory parameters, and prognostic scores, such as baseline model for end-stage liver disease (MELD) scores, were compared among patients of AIH with decompensated cirrhosis with mild/no ascites ( = 38), gross ascites ( = 24), and compensated cirrhosis ( = 32) when administered steroids. The primary outcome was transplant-free survival at 12 months. Biochemical remission rates and other adverse events were also assessed and compared between these groups.
Steroids were initiated at lower doses (25 mg/day-mild/no ascites, 20 mg/day-gross ascites) in patients with decompensated cirrhosis and at 40 mg/day in those with compensated cirrhosis. Transplant-free survival was 25.4%, 74.6%, and 96.9% ( = 0.001), and biochemical remission occurred in 5.1%, 49.0%, and 64.1% ( = 0.001) at 12 months in patients with gross ascites, mild/no ascites, and compensated cirrhosis, respectively. Infections were seen more frequently in decompensated cirrhosis, while other adverse events were comparable. Among decompensated cirrhosis, those with mild/no ascites had better prognostic scores, fewer posttreatment infections, and more frequent biochemical remission than those with gross ascites, achieving rates comparable to compensated cirrhosis. On multivariate analysis, the MELD score (subdistributional hazards ratio [sHR]; 95% confidence interval: 1.153 [1.07-1.24]; = 0.001) and ascites (sHR: 2.556 [1.565-5.65]; = 0.020) predicted survival.
Type and severity of decompensation affect outcomes in patients with AIH-related cirrhosis. Those with mild/no ascites have comparable outcomes to those with compensated cirrhosis upon treatment with low-dose steroids.
自身免疫性肝炎失代偿期肝硬化预后较差。除肝移植外，针对该病症的治疗方法尚不明确。我们探讨了患有活动性疾病的自身免疫性肝炎（AIH）相关失代偿期肝硬化患者接受类固醇治疗的结果。
在这项回顾性分析中，比较了接受类固醇治疗时，轻度/无腹水（n = 38）、大量腹水（n = 24）的AIH失代偿期肝硬化患者以及代偿期肝硬化患者（n = 32）的临床数据、实验室参数和预后评分，如终末期肝病模型（MELD）基线评分。主要结局是12个月时的无移植生存率。还评估并比较了这些组之间的生化缓解率和其他不良事件。
失代偿期肝硬化患者起始使用较低剂量的类固醇（轻度/无腹水患者为25mg/天，大量腹水患者为20mg/天），代偿期肝硬化患者为40mg/天。12个月时，大量腹水、轻度/无腹水和代偿期肝硬化患者的无移植生存率分别为25.4%、74.6%和96.9%（P = 0.001），生化缓解率分别为5.1%、49.0%和64.1%（P = 0.001）。失代偿期肝硬化患者感染更为常见，而其他不良事件相当。在失代偿期肝硬化患者中，轻度/无腹水患者的预后评分更好，治疗后感染更少，生化缓解更频繁，其发生率与代偿期肝硬化相当。多因素分析显示，MELD评分（亚分布风险比[sHR]；95%置信区间：1.153[1.07 - 1.24]；P = 0.001）和腹水（sHR：2.556[1.565 - 5.65]；P = 0.020）可预测生存情况。
失代偿的类型和严重程度会影响AIH相关肝硬化患者的结局。轻度/无腹水患者使用低剂量类固醇治疗后的结局与代偿期肝硬化患者相当。
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