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Predictive factors for remission and death in 73 patients with autoimmune hepatitis in Japan
Teruko Hino1, Ryukichi Kumashiro, Tatsuya Ide
1Second Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan. terukoh@med.kurume-u.ac.jp
Insights
Prognostic factors for autoimmune hepatitis (AIH) were identified in a Japanese cohort. Early prednisolone response and baseline total bilirubin, AST/ALT ratio, and IgG levels predict outcomes, guiding AIH treatment strategies.
Area of Science:
- Hepatology
- Immunology
- Internal Medicine
Background:
- The long-term prognosis of autoimmune hepatitis (AIH) remains incompletely understood.
- Defining prognostic factors is crucial for optimizing patient management and therapeutic strategies.
Purpose of the Study:
- To identify key prognostic factors for autoimmune hepatitis (AIH) in a Japanese population.
- To correlate baseline clinical and biochemical parameters with long-term disease activity and survival.
Main Methods:
- A retrospective analysis of 73 patients diagnosed with type 1 AIH between 1972 and 1999.
- Multivariate logistic regression and Cox regression analyses were employed to assess prognostic factors.
- Outcomes evaluated included complete remission, treatment-requiring normal alanine aminotransferase (ALT), and abnormal ALT levels despite medication.
Main Results:
- Factors associated with remission included lower total bilirubin (TB) and immunoglobulin G (IgG) levels.
- Factors predicting mortality were a higher aspartate aminotransaminase (AST)/ALT ratio and a poor response to initial prednisolone (PSL) therapy.
- During follow-up, 8 patients died from hepatic failure, hepatocellular carcinoma, or infection.
Conclusions:
- Achieving a prompt and effective response to initial prednisolone treatment is vital for improving AIH prognosis.
- Baseline TB, IgG levels, and the AST/ALT ratio are valuable indicators for tailoring therapeutic strategies in AIH patients.
Abstract:
The prognosis of patients with autoimmune hepatitis (AIH) has not been clearly defined. The aim of this study was to define the prognostic factors of AIH in a population with long-term follow-up in Japan. Seventy-three patients who were diagnosed as having type 1 AIH between January, 1972 - August, 1999 were enrolled in this study. Initial treatment included prednisolone (PSL) (n=62), other drug regimens (n=7), and none (n=4). We examined the relation between several factors obtained at diagnosis in relation to disease activity found at the final observation point (January, 2000 - April, 2000). Multivariate logistic regression and Cox regression were used for statistical analysis. During the observation period, 8 patients died of the following: hepatic failure (n=4), hepatocellular carcinoma (n=1), severe infection (n=1), and unknown causes (n=2). At the end point, the number of patients in complete remission was 13, those with a normal alanine aminotransferase (ALT) level requiring some treatment was 35, and those with an abnormal ALT level despite medication was 17. Factors related to remission were total bilirubin (TB) (Odds ratio, 0.87), and immunoglobulin G (IgG) (Odds ratio, 1.00). Factors related to death were the aspartate aminotransaminase (AST)/ALT ratio (Odds ratio, 11.67) and response to initial PSL regimen (Odds ratio, 0.03). The results of this study show an importance of achieving a good PSL response at onset, and that initial TB, the AST/ALT ratio, and IgG levels are useful for therapeutic strategy.