Severe acute autoimmune hepatitis: How to early predict who will not respond to corticosteroids and needs urgent liver transplantation?

• Type: Article in International Scientific Journal
• Date: 2022

Authors

Joao, M (Author) Other; Carvalhana, S (Author) Other; Moura, M (Author) Other; Freitas, LC (Author) Other; Silva, A (Author) Other; Figueiredo, P (Author) Other; Liberal, R (Author) Other; Macedo G (Author) FMUP; Cardoso, F (Author) Other; Pinto Marques, H (Author) Other; Marinho, RT (Author) Other; Cortez Pinto, H (Author) Other

Journal

Title: Digestive and Liver Disease

Vol. 54

Pages: 1681-1685

ISSN: 1590-8658

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 2 Citations

Other information

Authenticus ID: P-00Y-109

DOI: 10.1016/j.dld.2022.08.035

Abstract (EN): Backround: In acute severe autoimmune hepatitis (AS-AIH), the early identification of predictors of non -response to corticosteroids and the optimal timing for liver transplantation (LT) remains controversial. Aims: To determine early predictors of non-response to corticosteroids and to assess the usefulness of severity scores, namely the recently developed SURFASA. Methods: Retrospective multicentre cohort study including consecutive patients admitted for AS-AIH be-tween 2016 and 2020. Definitions-response to corticosteroids: LT-free survival at 90 days (D90); SURFASA score:-6.8 + 1.92x(D0-INR) + 1.94xINR[(D3-D0)/D0] + 1.64xbilirubin[(D3-D0)/D0]. Results: We included 26 patients [median age 56 (45-69) years; 22 (84.6%) women]. All patients un-derwent corticosteroid therapy. Overall survival reached 73%. amongst the non-responders, 2 (7.8%) un-derwent LT and 5 (19.2%) died. The interval between admission and initiation of corticosteroids was not different between responders and non-responders [13 (7-23) vs. 8 (3-10), P:0.06], respectively. SUR-FASA and MELD-Na+ (D3) scores showed an AUROC of 0.96 (0.87-1) and 0.92 (0.82-0.99), respectively, for prediction of non-response. SURFASA >-2.5 had a sensitivity of 85.7% and a specificity of 100% and MELD-Na+ (D3) > 26 had sensitivity of 85.7% and a specificity of 78% for the prediction of non-response. Conclusions: SURFASA and MELD-Na+ at D3 scores are useful in early identification of non-responders to corticosteroids.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 5