Clinical features and prognostic evaluation of 50 patients with acute severe autoimmune hepatitis

Abstract

Abstract: Objective To analyze the clinical features and prognostic evaluation of 50 patients with acute severe autoimmune hepatitis. Methods A retrospective analysis was conducted on the clinical data of 50 patients with acute severe autoimmune hepatitis admitted to our hospital from January 2015 to January 2023. Their clinical characteristics were analyzed. After one month of hormone treatment, they were divided into a survival group (n=40) and a death group (n=10) based on the prognosis. The clinical characteristics of the two groups were compared, and logistic regression models were used to analyze the risk factors affecting the prognosis of patients with acute severe autoimmune hepatitis. Methods Among the 50 patients with acute severe autoimmune hepatitis, 38 (76.0%) were aged 30-60 years old, 46 (92.0%) were female, and 41 (82.0%) were positive for antinuclear antibodies, accompanied by changes in multiple laboratory indicators (decreased albumin, increased total bilirubin, alanine aminotransferase, aspartate aminotransferase, platelet count, white blood cell count, and immunoglobulin G). The histological manifestations were mainly lymphocyte infiltration, hepatic lobular necrosis, and liver fibrosis. Moreover, the mortality risk was elevated(10 cases, 20.0%). Model for end-stage liver disease (MELD) score, total bilirubin level, and white blood cell count in the death group [(25.8 ± 6.2) points, (393.5 ± 25.1) μmol/L, (5.8±1.3) × 10⁹/L] were higher than those in the survival group [(19.4 ± 4.2) points, (242.6 ± 18.7) μmol/L, (3.9±0.7) × 10⁹/L](P<0.05). Logistic regression analysis showed that MELD score, total bilirubin level, and white blood cell count were risk factors affecting the prognosis of patients with acute severe autoimmune hepatitis (OR=5.249, 5.191, 4.918, P<0.05). Conclusion Acute severe autoimmune hepatitis exhibits specific clinical characteristics, often occurring in middle-aged women, accompanied by changes in multiple laboratory examination indicators, positive anti nuclear antibodies, and histological manifestations mainly characterized by lymphocyte infiltration, liver lobular necrosis, and liver fibrosis. The mortality risk is high, and clinical outcomes can be predicted based on MELD scores, total bilirubin levels, and white blood cell counts.

Key words: Acute severe, Autoimmune hepatitis, Clinical characteristics, Prognostic evaluation

SI Jin-mei, WANG Qian, CHEN Min, XU Xiao-guo, JI Hui-chun. Clinical features and prognostic evaluation of 50 patients with acute severe autoimmune hepatitis[J]. Chinese Hepatolgy, 2025, 30(1): 107-111.

References

[1] MackCL, Adams D, Assis DN, et al. Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hepatology, 2020, 72(2): 671-722.
[2] 徐天娇, 田华, 游绍莉, 等. 自身免疫性肝炎慢加急性肝衰竭的临床特征及预后分析. 肝脏, 2023, 28(2): 157-161.
[3] LohseAW, Sebode M, Bhathal PS, et al. Consensus recommendations for histological criteria of autoimmune hepatitis from the International AIH Pathology Group: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology. Liver Int, 2022, 42(5): 1058-1069.
[4] 蒋妮, 李俊峰, 李敏, 等. 急性重症自身免疫性肝炎治疗研究进展. 肝脏, 2022, 27(3): 370-373.
[5] 王绮夏, 蒋翔, 连敏, 等. 2015年欧洲肝病学会临床实践指南:自身免疫性肝炎. 临床肝胆病杂志, 2015, 31(12): 2000-2019.
[6] 沈怡, 文茂瑶, 凡小丽, 等. 急性自身免疫性肝炎临床研究进展. 四川医学, 2018, 39(2): 219-222.
[7] DeMartin E, Coilly A, Chazouillères O, et al. Early liver transplantation for corticosteroid non-responders with acute severe autoimmune hepatitis: The SURFASA score. J Hepatol, 2021, 74(6): 1325-1334.
[8] FujiwaraK, Fukuda Y, Seza K, et al. Analysis of non-severe acute onset autoimmune hepatitis according to the presence of radiological heterogeneity. Hepatol Res, 2022, 52(9): 804-810.
[9] DomereckaW, Kowalska-Kępczyńska A, Michalak A, et al. Etiopathogenesis and Diagnostic Strategies in Autoimmune Hepatitis. Diagnostics, 2021, 11(8): 1418.
[10] ZhengL, Liu Y, Shang Y, et al. Clinical characteristics and treatment outcomes of acute severe autoimmune hepatitis. BMC Gastroenterol, 2021, 21(1): 93.
[11] FujiwaraK, Fukuda Y, Seza K, et al. Long-term observation of acute-onset autoimmune hepatitis presenting clinically and radiologically as acute hepatitis. Hepatol Int, 2018, 12(2): 191-199.
[12] AssandriR, Montanelli A. Acute severe autoimmune hepatitis with anti-rods and rings autoantibodies; literature first evidence. Gastroenterol Hepatol Bed Bench, 2021, 14(1): 89-94.
[13] 郑林华, 尚玉龙, 韩者艺, 等. 急性重症自身免疫性肝炎的临床特征和预后分析. 中华肝脏病杂志, 2022, 30(1): 69-73.
[14] TéllezL, Sánchez Rodríguez E, Rodríguez de Santiago E, et al. Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study. Aliment Pharmacol Ther, 2022, 56(1): 131-143.
[15] JoãoM, Carvalhana S, Moura M, et al. Severe acute autoimmune hepatitis: How to early predict who will not respond to corticosteroids and needs urgent liver transplantation? Dig Liver Dis, 2022, 54(12): 1681-1685.
[16] NoguchiF, Chu PS, Yoshida A, et al. Early Dynamics of MELD Scores Predict Corticosteroid Responsiveness to Severe Acute-Onset Autoimmune Hepatitis. Clin Gastroenterol Hepatol, 2022, 20(11): 2641-2643.
[17] AljumahAA, Al-Ashgar H, Fallatah H, et al. Acute onset autoimmune hepatitis: Clinical presentation and treatment outcomes. Ann Hepatol, 2019, 18(3): 439-444.
[18] AnandL, Choudhury A, Bihari C, et al. Flare of Autoimmune Hepatitis Causing Acute on Chronic Liver Failure: Diagnosis and Response to Corticosteroid Therapy. Hepatology, 2019, 70(2): 587-596.
[19] SharmaS, Agarwal S, Gopi S, et al. Determinants of Outcomes in Autoimmune Hepatitis Presenting as Acute on Chronic Liver Failure Without Extrahepatic Organ Dysfunction upon Treatment With Steroids. J Clin Exp Hepatol, 2021, 11(2): 171-180.
[20] IkuraA, Chu PS, Nakamoto N, et al. CLIF-C Organ Failure Score and Liver Volume Predict Prognosis in Steroid-Treated Severe Acute Autoimmune Hepatitis. Hepatol Commun, 2020, 4(7): 1019-1033.