Abstract: Objective To evaluate the prognostic significance of clinical variables and hepatic histopathological changes in predicting the progression to liver fibrosis and cirrhosis in patients with autoimmune hepatitis(AIH).Methods Between August 2019 and August 2020, sixty-five patients with autoimmune hepatitis(AIH) were admitted to our hospital, and their clinical data were systematically collected. These patients were categorized into two groups based on the progression of their disease: a liver fibrosis group (n=35) and a cirrhosis group (n=30) . Comparative analyses of clinical variables and hepatic histological changes were conducted between these groups. Additionally, prognostic analysis of hormonal therapy and independent risk factors contributing to the development of hepatic fibrosis and cirrhosis in AIH patients were analyzed by multifactorial Logistic regression.Results In the liver fibrosis group of AIH patients, the mean duration of disease onset was (70.3±4.2) d , significantly longer than the (54.6±5.8) d, observed in the cirrhosis group(P<0.05). Notably, serum levels of total bilirubin, glutathione, glutathione, albumin, globulin, and IgG in the liver fibrosis group were (313.2±102.3) μmol/L, (353.5±65.4) U/L, (322.6±157.8) U/L, (27.2±4.5) g/L, (35.6±8.5) g/L, (28.6±8.3), respectively, which were markedly lower compared to the cirrhotic group [(412.5±101.6) μmol/L, (463.5±48.6) U/L, (420.5±156.3) U/L, (35.8±5.6) g/L, (43.6±8.6) g/L, (38.8±10.5), respectively, P<0.05]. The international normalized ratio was (1.7±0.2) points in the fibrosis group , which was more favorable than the (1.9±0.3) points in the cirrhosis group(P<0.05). The model for end-stage liver disease(MELD) socre was lower in the liver fibrosis group(22.1±2.6) compared to the cirrhosis group [(26.9±1.8), P<0.05]. Additionally, lymphocytic infiltration in confluent areas was less in the liver fibrosis group(5.7%) compared to 33.3% in the cirrhosis group(P<0.05). In terms of prognosis, the survival group showed significantly lower morbidity duration, total bilirubin levels, MELD score, and white blood cell count[(60.3±4.2) d, (243.2±92.3) μmol/L, (12.1±2.6) points, and (2.1±1.8) ×10⁹/L, respectively] compared to the death group[94.6±5.8) d, (412.5±121.6) μmol/L, (25.9±1.8) points, and (4.6±1.5) ×10⁹/L, respectively, P<0.05]; Multifactorial Logistic regression analysis identified duration of morbidity, elevated bilirubin, MELD score, and white blood cell count as independent risk factors for the development of liver fibrosis and cirrhosis in AIH(OR=4.646, 4.968, 5.078, 4.933, P<0.05).Conclusion The prognosis of patients with liver fibrosis and cirrhosis in AIH is closely associated with several key factors: the duration of the disease, total bilirubin levels, MELD score, and white blood cell count.

Key words: Hepatic histological changes, Autoimmune hepatitis, Liver fibrosis, cirrhosis, Prognosis