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 Saibara & 26 others Yoshiyuki 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

Research output: Contribution to journalArticle

26 Citations (Scopus)

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

Fingerprint

Autoimmune Hepatitis
International Normalized Ratio
Prothrombin Time
Prothrombin
Fatal Outcome
Steroids
Hepatitis
Communicable Diseases
Antinuclear Antibodies
Therapeutics
Serum
Bilirubin
Liver Transplantation
Smooth Muscle
Adrenal Cortex Hormones
Immunoglobulin G
Logistic Models

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Infectious Diseases

Cite this

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

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

In: Hepatology Research, Vol. 43, No. 6, 01.06.2013, p. 630-638.

Research output: Contribution to journalArticle

Yamamoto, K, Miyake, Y, Ohira, H, Suzuki, Y, Zeniya, M, Onji, M, Tsubouchi, H, Yoshizawa, K, Morizane, T, Hibi, T, Aoyagi, Y, Nakanuma, Y, Hirohara, J, Takikawa, H, Ishibashi, H, Shimoda, S, Sakisaka, S, Nakamuta, M, Matsuzaki, Y, Saibara, T, Ueno, Y, Miyakawa, H, Kokudo, N, Egawa, H, Maehara, Y, Mochida, S, Sakaida, I, Fujisawa, T, Suzuki, K, Inoue, K, Ichida, T, Yokosuka, O, Fukui, H, Moriwaki, H, Mori, M, Mori, T, Nagino, M, Sata, N, Tazuma, S, Yasaka, T, Tsuyuguchi, T, Shoda, J, Honda, M, Yamaue, H, Unno, M & Hayashi, N 2013, 'Prognosis of autoimmune hepatitis showing acute presentation', Hepatology Research, vol. 43, no. 6, pp. 630-638. https://doi.org/10.1111/j.1872-034X.2012.01109.x
Yamamoto K, Miyake Y, Ohira H, Suzuki Y, Zeniya M, Onji M et al. Prognosis of autoimmune hepatitis showing acute presentation. Hepatology Research. 2013 Jun 1;43(6):630-638. https://doi.org/10.1111/j.1872-034X.2012.01109.x
Yamamoto, Kazuhide ; Miyake, Yasuhiro ; Ohira, Hiromasa ; Suzuki, Yoshiyuki ; Zeniya, Mikio ; Onji, Morikazu ; Tsubouchi, Hirohito ; Yoshizawa, Kaname ; Morizane, Toshio ; Hibi, Toshifumi ; Aoyagi, Yutaka ; Nakanuma, Yasuni ; Hirohara, Junko ; Takikawa, Hajime ; Ishibashi, Hiromi ; Shimoda, Shinji ; Sakisaka, Shotaro ; Nakamuta, Makoto ; Matsuzaki, Yasushi ; Saibara, Toshiji ; Ueno, Yoshiyuki ; Miyakawa, Hiroshi ; Kokudo, Norihiro ; Egawa, Hiroto ; Maehara, Yoshihiko ; Mochida, Satoshi ; Sakaida, Isao ; Fujisawa, Tomoo ; Suzuki, Kazuyuki ; Inoue, Kazuaki ; Ichida, Takafumi ; Yokosuka, Osamu ; Fukui, Hiroshi ; Moriwaki, Hisataka ; Mori, Mitsuru ; Mori, Toshiyuki ; Nagino, Masato ; Sata, Naohiro ; Tazuma, Susumu ; Yasaka, Takahiro ; Tsuyuguchi, Toshio ; Shoda, Junichi ; Honda, Masao ; Yamaue, Hiroki ; Unno, Michiaki ; Hayashi, Norio. / Prognosis of autoimmune hepatitis showing acute presentation. In: Hepatology Research. 2013 ; Vol. 43, No. 6. pp. 630-638.
@article{98ab09c5017d49fa9d67dda90f60cb47,
title = "Prognosis of autoimmune hepatitis showing acute presentation",
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.",
author = "Kazuhide Yamamoto and Yasuhiro Miyake and Hiromasa Ohira and Yoshiyuki Suzuki and Mikio Zeniya and Morikazu Onji and Hirohito Tsubouchi and Kaname Yoshizawa and Toshio Morizane and Toshifumi Hibi and Yutaka Aoyagi and Yasuni Nakanuma and Junko Hirohara and Hajime Takikawa and Hiromi Ishibashi and Shinji Shimoda and Shotaro Sakisaka and Makoto Nakamuta and Yasushi Matsuzaki and Toshiji Saibara and Yoshiyuki Ueno and Hiroshi Miyakawa and Norihiro Kokudo and Hiroto Egawa and Yoshihiko Maehara and Satoshi Mochida and Isao Sakaida and Tomoo Fujisawa and Kazuyuki Suzuki and Kazuaki Inoue and Takafumi Ichida and Osamu Yokosuka and Hiroshi Fukui and Hisataka Moriwaki and Mitsuru Mori and Toshiyuki Mori and Masato Nagino and Naohiro Sata and Susumu Tazuma and Takahiro Yasaka and Toshio Tsuyuguchi and Junichi Shoda and Masao Honda and Hiroki Yamaue and Michiaki Unno and Norio Hayashi",
year = "2013",
month = "6",
day = "1",
doi = "10.1111/j.1872-034X.2012.01109.x",
language = "English",
volume = "43",
pages = "630--638",
journal = "Hepatology Research",
issn = "1386-6346",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Prognosis of autoimmune hepatitis showing acute presentation

AU - Yamamoto, Kazuhide

AU - Miyake, Yasuhiro

AU - Ohira, Hiromasa

AU - Suzuki, Yoshiyuki

AU - Zeniya, Mikio

AU - Onji, Morikazu

AU - Tsubouchi, Hirohito

AU - Yoshizawa, Kaname

AU - Morizane, Toshio

AU - Hibi, Toshifumi

AU - Aoyagi, Yutaka

AU - Nakanuma, Yasuni

AU - Hirohara, Junko

AU - Takikawa, Hajime

AU - Ishibashi, Hiromi

AU - Shimoda, Shinji

AU - Sakisaka, Shotaro

AU - Nakamuta, Makoto

AU - Matsuzaki, Yasushi

AU - Saibara, Toshiji

AU - Ueno, Yoshiyuki

AU - Miyakawa, Hiroshi

AU - Kokudo, Norihiro

AU - Egawa, Hiroto

AU - Maehara, Yoshihiko

AU - Mochida, Satoshi

AU - Sakaida, Isao

AU - Fujisawa, Tomoo

AU - Suzuki, Kazuyuki

AU - Inoue, Kazuaki

AU - Ichida, Takafumi

AU - Yokosuka, Osamu

AU - Fukui, Hiroshi

AU - Moriwaki, Hisataka

AU - Mori, Mitsuru

AU - Mori, Toshiyuki

AU - Nagino, Masato

AU - Sata, Naohiro

AU - Tazuma, Susumu

AU - Yasaka, Takahiro

AU - Tsuyuguchi, Toshio

AU - Shoda, Junichi

AU - Honda, Masao

AU - Yamaue, Hiroki

AU - Unno, Michiaki

AU - Hayashi, Norio

PY - 2013/6/1

Y1 - 2013/6/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84878781342&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878781342&partnerID=8YFLogxK

U2 - 10.1111/j.1872-034X.2012.01109.x

DO - 10.1111/j.1872-034X.2012.01109.x

M3 - Article

VL - 43

SP - 630

EP - 638

JO - Hepatology Research

JF - Hepatology Research

SN - 1386-6346

IS - 6

ER -