Clinical characteristics and prognosis of patients with autoimmune hepatitis -induced acute on chronic liver failure

Abstract

Abstract: Objective To investigate the clinical characteristics and prognosis of autoimmune hepatitis acute on chronic liver failure (AIH-ACLF). Methods The clinical characteristics of 36 patients with AIH-ACLF treated in our hospital from January 2016 to December 2020 were retrospectively analyzed. According to the prognosis, patients were divided into improvement group and ineffective group, and the data between the 2 groups were compared. T test and rank sum test were used to analyze the data of classified variables, Logistic regression was used for multivariate analysis. Results Among the 36 cases, 32 were female (88.89%) and the average age was 52.29 ± 16.27 years. All the cases were AIH type 1 and had never received corticosteroid therapy before, 86.1% of patients combined with liver cirrhosis. The total improvement rate was 27.8% (10 cases), and 2 cases were treated with liver transplantation. Ascitic fluid (34 cases, 94.4%) and hepatic encephalopathy (HE) (20 cases, 55.6%) were the most common complications. Compared with the ineffective group, the prothrombin activity (PTA) in the improved group was higher [32.80 (26.25～37.70)% vs 22.95 (14.86～35.25)%, P=0.044]; the total bilirubin (TBil) (171.03±69.19μmol/L vs 261.23±131.00μmol/L, P=0.012), model for end-stage liver disease (MELD) score [19.00 (17.75～23.50) vs 29.50 (24.25～34.25), P<0.001)] and the incidence of HE (20% vs 69.2%, P=0.011) was lower. The proportion of patients treated with corticosteroid therapy was high (80.0% vs 26.9%, P=0.007). Corticosteroid therapy and MELD score were independent risk factors for prognosis of AIH-ACLF. Fifteen patients (41.2%) received corticosteroid therapy, and 8 of them improved. The interval time from diagnosis to corticosteroid therapy and MELD scores of improved patients were lower. Conclusion The prognosis of patients with AIH-ACLF is poor, corticosteroid therapy and MELD score are independent risk factors for prognosis. Early corticosteroid therapy are essential for improving the prognosis of patients with AIH-ACLF.

Key words: Autoimmune hepatitis, Liver failure, Risk factors, Prognosis

XU Tian-jiao, TIAN Hua, YOU Shao-li, ZHU Bing, LV Sa. Clinical characteristics and prognosis of patients with autoimmune hepatitis -induced acute on chronic liver failure[J]. Chinese Hepatolgy, 2023, 28(2): 157-161.

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