Worse fibro-inflammatory activity on diagnostic liver biopsy adversely impacts biochemical remission in autoimmune hepatitis - 07/08/24
Highlights |
• | Achieving biochemical remission in patients with autoimmune hepatitis prevents progression to end stage liver disease. |
• | A review of the pre-treatment liver biopsy slides for pediatric and adult patients with autoimmune hepatitis was conducted by three pathologists blinded to clinical information. |
• | Findings of advanced fibrosis on diagnostic liver biopsy of patients with autoimmune hepatitis was accompanied by more pronounced necro-inflammatory activity, lower platelet levels and higher serum immunoglobulin G levels. |
• | Advanced fibrosis on diagnostic liver biopsy translated to lower rates of biochemical remission during the first year after diagnosis. |
• | Pediatric age at diagnosis and advanced fibrosis on diagnostic liver biopsy were associated with higher steroid exposure at 1 year post diagnosis. |
Abstract |
Background |
Autoimmune hepatitis (AIH) patients can present with advanced fibrosis at diagnosis or may progress to the same if biochemical remission on treatment is not achieved.
Methods |
We conducted a single-center retrospective analysis of 34 pediatrics and 39 adult AIH patients. Three pathologists, blinded to clinical information, reviewed the diagnostic liver biopsy (DLB) slides of AIH patients. We evaluated the impact of clinical, laboratory, and histopathologic parameters on outcomes including biochemical remission (BR).
Results |
Incidence of advanced (Ludwig stage 3 or 4) fibrosis on DLB was 45.2 %. AIH patients with advanced fibrosis had higher median Ishak score (p < 0.001) and higher IgG level (p = 0.01) at diagnosis. The incidence of BR at 6-month (31.2% vs. 88.6 %, p = 0.001) and 1-year (68.8% vs. 88.6 %, p = 0.04) post-diagnosis was significantly lower in AIH patients with advanced fibrosis. Although not statistically significant, a higher proportion of AIH patients with advanced fibrosis were on high dose of steroids (58% vs. 37.9 %, p = 0.1) at 1 year post diagnosis. Higher serum IgG level at diagnosis was associated with lower odds of achieving BR at 6-month (p = 0.004) and 1-year (p = 0.03) post-diagnosis in multivariate analysis. Pediatric age at diagnosis (p = 0.02) was associated with higher steroid dose at 1-year post-diagnosis in univariate analysis.
Conclusions |
Findings of advanced fibrosis on DLB of AIH patients was accompanied by more pronounced necro-inflammatory activity and higher serum IgG level, which translated to lower rates of BR and higher exposure to steroids during the first year after diagnosis.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Autoimmune hepatitis, Biochemical remission, Fibrosis, Platelet count, Immunoglobulin G
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Vol 48 - N° 8
Articolo 102442- Ottobre 2024 Ritorno al numero
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