Hepatic Encephalopathy and MELD-Na Predict Treatment Benefit in Autoimmune Hepatitis-related Decompensated Cirrhosis.
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Arvaniti Pinelopi, Rodríguez-Tajes Sergio, Padilla Marlene, Olivas Ignasi, Mauro Ezequiel, El Maimouni Cautar, Lytvyak Ellina, Verhelst Xavier, Engel Bastian, Taubert Richard, Lorente-Pérez Sara, Conde Isabel, Riveiro-Barciela Mar, Ruiz-Cobo Juan-Carlos, Álvarez-Navascués Carmen, Salcedo Magdalena, Gómez Judith, Janik Maciej K, Mateos Beatriz, Efe Cumali, Granito Alessandro, Dajti Elton, Azzaroli Francesco, Horta Diana, Vila Carmen, Castello Inmaculada, Pérez-Medrano Indhira, Arencibia Ana, Gerussi Alessio, Bruns Tony, Colaprieto Francesca, Lleo Ana, Van den Ende Natalie, Verbeek Jef, Díaz-González Álvaro, Morillas Rosa Ma, Torner-Simó Maria, Bernal Vanesa, Fernández Eva-Maria, Gevers Tom J G, Terziroli Beretta-Piccoli Benedetta, Gómez Elena, Cuenca Paqui, de Boer Ynte S, Kerkar Nanda, Assis David N, Liberal Rodrigo, Drenth Joost P H, Tana Michele M, Sebode Marcial, Schregel Ida, Schramm Christoph, Lohse Ansgar W, Montano-Loza Aldo J, Zachou Kalliopi, Villamil Alejandra, Dalekos George N, Londoño María-Carlota, International Autoimmune Hepatitis Group (IAIHG), European Reference Network on Hepatological Diseases (ENR RARE-LIVER), Spanish Registry for Autoimmune and Cholestatic Diseases (ColHai) Registry
Аннотация
METHODS: This retrospective, international, multicenter study included 232 patients with histologically confirmed AIH-related decompensated cirrhosis at diagnosis. The sub-hazard ratio (SHR) of mortality was determined by competing risk analysis, considering liver transplantation (LT) as competing event. A decision tree analysis was used to develop a treatment algorithm.
RESULTS: At diagnosis, 89% of patients had ascites, and 41% had overt hepatic encephalopathy (OHE). Treated patients (n = 214; 92%) had higher aminotransferases, bilirubin, and modified hepatic activity index. The SHR of mortality was lower in treated patients (0.438; 95% confidence interval [CI], 0.196-0.981; P = .045). Patients without OHE grade 3/4 and Model for End-Stage Liver Disease-Sodium (MELD-Na) ≤28 at diagnosis were more likely to benefit from treatment. In these patients, a decline in MELD-Na ≥11 after 4 weeks of treatment had a 100% negative predictive value for death/LT. Forty-nine percent of treated patients recompensated during follow-up. Twenty percent of patients had to discontinue treatment, 65% during the first 4 weeks, and only 4% due to infectious complications. OHE ≥grade 2 and MELD-Na at diagnosis predicted the need for treatment discontinuation.
CONCLUSIONS: Immunosuppression is beneficial in patients with AIH-related decompensated cirrhosis and active disease. OHE and MELD-Na at diagnosis, along with a decline in MELD-Na at 4 weeks of treatment, are the most important determinants of outcome and can guide treatment decisions.