Autoimmune Hepatitis with Acute Presentation: Clinical, Biochemical, and Histological Features of 126 Patients
Introduction. Autoimmune hepatitis (AIH) is a chronic liver disease with a relevant inflammatory component and an unknown etiology. Evidence for clinical characteristics and risk factors in large cohorts of patients with acute AIH (AAIH) is lacking. We clinically characterized patients with AAIH, th...
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| Format: | Article |
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Wiley
2022-01-01
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| Series: | Canadian Journal of Gastroenterology and Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2022/6470847 |
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| author | Álvaro Urzúa Carolina Pizarro Abraham Gajardo Rafael Poniachik Claudia Pavez Máximo Cattaneo Javier Brahm Laura Carreño Jaime Poniachik |
| author_facet | Álvaro Urzúa Carolina Pizarro Abraham Gajardo Rafael Poniachik Claudia Pavez Máximo Cattaneo Javier Brahm Laura Carreño Jaime Poniachik |
| author_sort | Álvaro Urzúa |
| collection | DOAJ |
| description | Introduction. Autoimmune hepatitis (AIH) is a chronic liver disease with a relevant inflammatory component and an unknown etiology. Evidence for clinical characteristics and risk factors in large cohorts of patients with acute AIH (AAIH) is lacking. We clinically characterized patients with AAIH, the prevalence of a combined adverse outcome (death or liver transplantation (LT)), and its risk factors. Methods. A retrospective study of adult patients diagnosed with AAIH at three centers (Santiago, Chile; 2000–2018) was conducted. Clinical and laboratory characteristics were obtained. A liver biopsy was performed for all patients. Descriptive statistics and logistic regression models were used. Results. A total of 126 patients were admitted; 77% were female, 33 (26.2%) had a severe presentation, and 14 (11.1%) had a fulminant presentation. Overall, 24 patients (19.0%) lacked typical autoantibodies, and 26.2% had immunoglobulin G levels in the normal range. The most frequent histological findings were plasma cells (86.5%), interface hepatitis (81.7%), and chronic hepatitis (81.0%). Rosettes were uncommon (35.6%). Advanced fibrosis was present in 27% of patients. Combined adverse outcomes occurred in 7.9% of cases, all fulminant with histological cholestasis. Alkaline phosphatase, bilirubin, and prothrombin less than 50% were independent risk factors for in-hospital death or LT (p value <0.05). Although corticosteroid treatment was associated with better outcomes (OR 0.095, p value = 0.013), more severe patients were less likely to receive this therapy. Discussion. In this large cohort of patients with AAIH, clinical characteristics differ from those reported in patients with chronic AIH. Fulminant hepatitis, histological cholestasis, alkaline phosphatase, bilirubin, and prothrombin were associated with death/LT. |
| format | Article |
| id | doaj-art-ec598152cbc646bf9c8ac5ed72b8cebc |
| institution | Kabale University |
| issn | 2291-2797 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology and Hepatology |
| spelling | doaj-art-ec598152cbc646bf9c8ac5ed72b8cebc2025-02-03T01:22:53ZengWileyCanadian Journal of Gastroenterology and Hepatology2291-27972022-01-01202210.1155/2022/6470847Autoimmune Hepatitis with Acute Presentation: Clinical, Biochemical, and Histological Features of 126 PatientsÁlvaro Urzúa0Carolina Pizarro1Abraham Gajardo2Rafael Poniachik3Claudia Pavez4Máximo Cattaneo5Javier Brahm6Laura Carreño7Jaime Poniachik8Hospital Clínico Universidad de ChileHospital Clínico Universidad de ChileHospital Clínico Universidad de ChileHospital Clínico Universidad de ChileHospital Clínico Universidad de ChileHospital Clínico Universidad de ChileClínica Las CondesHospital Clínico Universidad de ChileHospital Clínico Universidad de ChileIntroduction. Autoimmune hepatitis (AIH) is a chronic liver disease with a relevant inflammatory component and an unknown etiology. Evidence for clinical characteristics and risk factors in large cohorts of patients with acute AIH (AAIH) is lacking. We clinically characterized patients with AAIH, the prevalence of a combined adverse outcome (death or liver transplantation (LT)), and its risk factors. Methods. A retrospective study of adult patients diagnosed with AAIH at three centers (Santiago, Chile; 2000–2018) was conducted. Clinical and laboratory characteristics were obtained. A liver biopsy was performed for all patients. Descriptive statistics and logistic regression models were used. Results. A total of 126 patients were admitted; 77% were female, 33 (26.2%) had a severe presentation, and 14 (11.1%) had a fulminant presentation. Overall, 24 patients (19.0%) lacked typical autoantibodies, and 26.2% had immunoglobulin G levels in the normal range. The most frequent histological findings were plasma cells (86.5%), interface hepatitis (81.7%), and chronic hepatitis (81.0%). Rosettes were uncommon (35.6%). Advanced fibrosis was present in 27% of patients. Combined adverse outcomes occurred in 7.9% of cases, all fulminant with histological cholestasis. Alkaline phosphatase, bilirubin, and prothrombin less than 50% were independent risk factors for in-hospital death or LT (p value <0.05). Although corticosteroid treatment was associated with better outcomes (OR 0.095, p value = 0.013), more severe patients were less likely to receive this therapy. Discussion. In this large cohort of patients with AAIH, clinical characteristics differ from those reported in patients with chronic AIH. Fulminant hepatitis, histological cholestasis, alkaline phosphatase, bilirubin, and prothrombin were associated with death/LT.http://dx.doi.org/10.1155/2022/6470847 |
| spellingShingle | Álvaro Urzúa Carolina Pizarro Abraham Gajardo Rafael Poniachik Claudia Pavez Máximo Cattaneo Javier Brahm Laura Carreño Jaime Poniachik Autoimmune Hepatitis with Acute Presentation: Clinical, Biochemical, and Histological Features of 126 Patients Canadian Journal of Gastroenterology and Hepatology |
| title | Autoimmune Hepatitis with Acute Presentation: Clinical, Biochemical, and Histological Features of 126 Patients |
| title_full | Autoimmune Hepatitis with Acute Presentation: Clinical, Biochemical, and Histological Features of 126 Patients |
| title_fullStr | Autoimmune Hepatitis with Acute Presentation: Clinical, Biochemical, and Histological Features of 126 Patients |
| title_full_unstemmed | Autoimmune Hepatitis with Acute Presentation: Clinical, Biochemical, and Histological Features of 126 Patients |
| title_short | Autoimmune Hepatitis with Acute Presentation: Clinical, Biochemical, and Histological Features of 126 Patients |
| title_sort | autoimmune hepatitis with acute presentation clinical biochemical and histological features of 126 patients |
| url | http://dx.doi.org/10.1155/2022/6470847 |
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