Clinical, biochemical and histological features of 82 cases of acute autoimmune hepatitis

Abstract

Abstract: Objective To analyze the clinical, biochemical and histological characteristics of patients with acute autoimmune hepatitis (AAIH). Methods Between January 2010 and October 2022, 82 patients with AAIH who underwent liver biopsy were reviewed, including 13 males and 61 females, aged (53.2±8.7) years. All cases met the diagnostic criteria for AIH and AAIH. Patients were classified into three groups based on their International Normalized Ratio(INR) status and the presence of hepatic encephalopathy: acute non-severe cases(INR<1.5), acute severe cases(INR>1/5, with no hepatic encephalopathy), and fulminate cases(acute severe cases where hepatic encephalopathy occurred within 26 weeks post-jaundice onset). The clinical and pathological data of each group were compared, and the influencing factors of AAIH patients' conditions were discussed by multivariate Logistic regression analysis. Results There were 52 cases of non-severe, 21 cases of acute severe and 9 cases of fulminant AAIH, respectively. The TBil level and prothrombin activity in non-severe cases were 101.6 (28.0, 202.5) μmol/L, 74 (55, 87) %, respectively. Compared with those in acute severe cases [211.6 (150.9, 381.3) μmol/L, 42 (33, 58) %] and fulminant cases [352.2 (215.1, 492.4) μmol/L, 31 (22, 50) %], the differences were statistically significant (P<0.05). There were 49 cases (94.2%), 13 cases (61.9%) and 5 cases (55.5%) of acute non-severe, acute severe and fulminant AAIH patients, respectively, and the difference was statistically significant (P<0.05). Taking the conditions of AAIH patients (assignment 0= acute non-severe, 1= acute severe and fulminant) as dependent variables, and TBil, prothrombin activity and steroid use (assignment 0= used, 1= unused) as independent variables, multivariate Logistic regression analysis showed that TBil, prothrombin activity and steroid use were independent predictors of AAIH patients' condition (P<0.05). There were 15 cases (28.8%), 10 cases (47.6%) and 8 cases (88.9%) of acute non-severe, acute severe and fulminant AAIH patients with cholestasis, and the difference was statistically significant (P<0.05). There were 26 cases (50.0%), 12 cases (23.1%) and 14 cases (26.9%) of non-severe mild, moderate and severe central lobular necrosis, compared with acute severe [4 cases (19.0%), 2 cases (9.5%) and 15 cases (71.4%)] and fulminant [3 cases (33.3%), 0 (0) and 6 cases (66.7%)], and the difference was statistically significant (P<0.05). Conclusion Compared with chronic AIH, AAIH patients have differences in clinical manifestations, laboratory data and histological results. Fulminant hepatitis, cholestasis, TBil and prothrombin activity are risk factors for the prognosis of AAIH patients.

Key words: Autoimmune hepatitis, Prothrombin activity, Cholestasis, Logistic regression analysis

WANG Hui-chi, TIAN Lu, ZHENG Yi, ZHAO Peng, DONG Hai-ling, BIAN Yu-yao. Clinical, biochemical and histological features of 82 cases of acute autoimmune hepatitis[J]. Chinese Hepatolgy, 2023, 28(6): 716-719.

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