AP & T: Patients with acute severe self -immune hepatitis received early predictive factors that responded to corticosteroid treatment

Autoimmune hepatitis (AIH) is an immune-mediated necrotic inflammatory liver disease. When patients have acute attacks (<30 days) and international standardization ratio (INR) ≥ 1.5 AIH). Among patients with 50%-60%, AS-AIH progressed to acute liver failure (ALF), with poor prognosis and a mortality rate of up to 20%. The current guidelines are recommended to use corticosteroids for rescue, and then emergency liver transplantation. In addition, immunosuppression may increase the risk of infection and damage the prognosis and liver transplantation. Therefore, the purpose of this study is: (i) assessing whether corticosteroids can improve the prognosis, and (ii) determine the factors that occur and treat early in the treatment to predict the individual's response to this treatment.

This is a retrospective queue study that includes all AS-AIH patients who were treated in 13 tertiary centers in the United States from January 2002 to January 2019. The main observation ending is death or liver transplantation within 90 days after admission. Kaplan-Meier and Cox regression methods are used for data statistics analysis.

Among the 242 patients (average age [SD] 49.7 [16.8]), 203 were treated with corticosteroids. The overall 90 -day survival rate is 61.6% (95% confident interval [CI] 55.4–67.7). Corticosteroids reduce the risk of bad ending (the risk ratio of [HR] 0.25; 95% CI 0.2–0.4), but this treatment failure rate is 30.5%. An internal verified line diagram consists of analogy, MELD, encephalopathy, and corticosteroids at the beginning of ascites, accurately predicting the reaction (C-Index 0.82; [95% CI 0.8–0.9]). Among the responders, Meld has improved significantly from the 3rd day to the 14th, but it remains unchanged among those without response. Day 7's MELD deadline is 25 (sensitivity 62.5% [95% CI: 47.0–75.8]; specificity 95.2% [95% CI: 89-197.8]) is the best single variable prediction factor for reaction. Extending the use of corticosteroids will not increase the risk of overall infection (the adjusted HR 0.75; 95% CI 0.3-2.1).

This study has confirmed that when steroid therapy starts and during treatment, elderly patients with high MELD, encephalopathy or ascites are unlikely to show good treatment reactions. Therefore, these patients should be avoided By.

Primitive source:

Luis téllez. Et al. Early Predictors of Corticosteroid Response in Acute Seveimmmune Hepatitis: a National Wide Multice Study. AliMentary Pharmacology & therapet.

Author: xuyihan

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