Prognosis of autoimmune hepatitis showing acute presentation

Kazuhide Yamamoto, Yasuhiro Miyake, Hiromasa Ohira, Yoshiyuki Suzuki, Mikio Zeniya, Morikazu Onji, Hirohito Tsubouchi, Kaname Yoshizawa, Toshio Morizane, Toshifumi Hibi, Yutaka Aoyagi, Yasuni Nakanuma, Junko Hirohara, Hajime Takikawa, Hiromi Ishibashi, Shinji Shimoda, Shotaro Sakisaka, Makoto Nakamuta, Yasushi Matsuzaki, Toshiji SaibaraYoshiyuki Ueno, Hiroshi Miyakawa, Norihiro Kokudo, Hiroto Egawa, Yoshihiko Maehara, Satoshi Mochida, Isao Sakaida, Tomoo Fujisawa, Kazuyuki Suzuki, Kazuaki Inoue, Takafumi Ichida, Osamu Yokosuka, Hiroshi Fukui, Hisataka Moriwaki, Mitsuru Mori, Toshiyuki Mori, Masato Nagino, Naohiro Sata, Susumu Tazuma, Takahiro Yasaka, Toshio Tsuyuguchi, Junichi Shoda, Masao Honda, Hiroki Yamaue, Michiaki Unno, Norio Hayashi

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Abstract

Aim: The number of patients with autoimmune hepatitis (AIH) showing acute presentation has increased. This study aimed to assess their prognosis. Methods: A survey of AIH patients by sending questionnaires was performed, and 96 patients showing acute presentation were investigated. Results: The median age was 58 years and 78 patients (81%) were female. Eighty-four patients (88%) were positive for antinuclear antibody and/or anti-smooth muscle antibody. The median serum immunoglobulin G level was 2252mg/dL. Twenty-five patients (26%) showed histological acute hepatitis. As initial treatment, 88 patients (92%) were treated with corticosteroid, and 28 of them received pulse steroid treatment. Overall, 11 patients (11%) reached fatal outcomes (nine death and two liver transplantation). Patients with histological acute hepatitis showed higher serum bilirubin levels, lower prothrombin activities and higher prothrombin time-international normalized ratios (PT-INR) and reached fatal outcomes more frequently. With a multivariate logistic regression analysis, prothrombin activity and PT-INR at presentation was associated with fatal outcomes. Nine of 13 patients (69%) showing prothrombin activity of 40% or lower at presentation and nine of 19 patients (47%) showing PT-INR of 1.5 or higher reached fatal outcomes. Furthermore, of 13 patients showing prothrombin activity of 40% or lower and/or PT-INR of 1.5 or higher at presentation who were treated with pulse steroid treatment, four (31%) died from infectious disease. Conclusion: Prothrombin activity and PT-INR are prognostic factors for AIH showing acute presentation. Physicians should pay attention to the development of infectious disease when pulse steroid treatment is performed.

Original languageEnglish
Pages (from-to)630-638
Number of pages9
JournalHepatology Research
Volume43
Issue number6
DOIs
Publication statusPublished - Jun 1 2013

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All Science Journal Classification (ASJC) codes

  • Hepatology
  • Infectious Diseases

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Yamamoto, K., Miyake, Y., Ohira, H., Suzuki, Y., Zeniya, M., Onji, M., ... Hayashi, N. (2013). Prognosis of autoimmune hepatitis showing acute presentation. Hepatology Research, 43(6), 630-638. https://doi.org/10.1111/j.1872-034X.2012.01109.x