Autoimmune hepatitis presenting as acute liver failure: A 20-year retrospective review of North America.
Liver Transpl
; 29(6): 570-580, 2023 06 01.
Article
em En
| MEDLINE
| ID: mdl-36825579
ABSTRACT
Autoimmune hepatitis is aâ¯common causeâ¯of acute liver failure.â¯Treatmentâ¯includesâ¯steroidsâ¯for acute liver injury and liver transplantation in those who fail to respond or develop acute liver failure.â¯The aim of this study is to further characterize acute liver failure secondary to autoimmune hepatitis and identify variables that predictâ¯21-dayâ¯transplant-free survival. This study included adults hospitalized with acute liver failure enrolled in the Acute Liver Failure Study Group Registry between 1998 and 2019 from 32 centers within the US.â¯The etiology of all cases was reviewed by the Adjudication Committee, and all casesâ¯identified as autoimmune hepatitisâ¯wereâ¯included.â¯Acute liver injury was defined as an INR ≥2.0 without encephalopathy and acute liver failure as INR ≥ 1.5 with encephalopathy. Laboratory and clinical data were reviewed. Variables significantly associated withâ¯21-dayâ¯transplant-free survivalâ¯wereâ¯used to develop a multivariable logistic regression model. â¯A total of 193 cases of acute liver failure secondary to autoimmune hepatitis were identified and reviewed.â¯There were 161 patients (83.4%) diagnosed with acute liver failure on enrollment, and 32 (16.6%) developed acute liver failure during hospitalization.â¯At 21 days,â¯115 (59.6%)â¯underwentâ¯liver transplantation, 28 (14.5%) hadâ¯transplant-free survival, and 46 (23.8%) died before liver transplantation. Higher admission values ofâ¯bilirubin, INR, and coma grade were associated with worse outcomes. A prognostic index incorporating bilirubin, INR, coma grade, and platelet count had a concordance statistic of 0.84. Acute liver failure secondary to autoimmune hepatitis isâ¯associated with a high short-term mortality.â¯We developed a model specifically for autoimmune hepatitis thatâ¯may be helpful in predicting 21-dayâ¯transplant-free survival andâ¯early identification of patients in need of expeditedâ¯liver transplantâ¯evaluation.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Encefalopatias
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Transplante de Fígado
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Falência Hepática Aguda
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Hepatite Autoimune
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article