The Management of Autoimmune Hepatitis Patients with Decompensated Cirrhosis: Real-World Experience and a Comprehensive Review

Zhaoyue Wang, Li Sheng, Yue Yang, Fan Yang, Xiao Xiao, Jing Hua, Canjie Guo, Yiran Wei, Ruqi Tang, Qi Miao, Jun Zhang, Yanmei Li, Jingyuan Fang, Dekai Qiu, Edward L. Krawitt, Christopher Bowlus, M. Eric Gershwin, Qixia Wang, Xiong Ma

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

There is a paucity of information related to the usefulness of corticosteroid therapy in autoimmune hepatitis (AIH) with decompensated cirrhosis. In this study, we sought to determine the therapeutic effect of corticosteroids in this special group of AIH patients. Eighty-two AIH patients with decompensated cirrhosis were included through a retrospective analysis from January 2009 to September 2015. Sixty-four patients were treated with corticosteroids while 18 patients did not receive any corticosteroids. Clinical, laboratory, and histological characteristics and outcomes were analyzed comparing corticosteroid-treated and untreated groups. Patients that did not receive corticosteroids were older than corticosteroid-treated patients and had a worse survival. In corticosteroid-treated group, 40 of 64 patients reverted to compensated state and 15 patients remained decompensated, while 9 patients experienced liver-related death or transplantation. Patients who reverted to compensated state had significantly greater ALT, AST, GGT, white blood cell count, and platelet levels at presentation. Changes (Δ) in total bilirubin (TBIL) and MELD scores at day 7 after starting corticosteroid therapy revealed favorable predictive effects of treatment outcomes. Survival was significantly greater in patients with a ΔTBIL <−0.196 mg/dL (p = 0.001) 7 days after treatment. Infection was the most common cause of death or transplantation in the patients with treatment failure. Although it cannot be determined whether the results were due to the therapy or underlying patient characteristics, survival was greater in the corticosteroid-treated group with the benefit being greatest in patients with the greatest decrease in TBIL at day 7 after starting corticosteroid therapy.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalClinical Reviews in Allergy and Immunology
DOIs
StateAccepted/In press - Aug 11 2016

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Keywords

  • Autoimmune hepatitis
  • Corticosteroids
  • Decompensated cirrhosis
  • Prognosis

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Wang, Z., Sheng, L., Yang, Y., Yang, F., Xiao, X., Hua, J., Guo, C., Wei, Y., Tang, R., Miao, Q., Zhang, J., Li, Y., Fang, J., Qiu, D., Krawitt, E. L., Bowlus, C., Gershwin, M. E., Wang, Q., & Ma, X. (Accepted/In press). The Management of Autoimmune Hepatitis Patients with Decompensated Cirrhosis: Real-World Experience and a Comprehensive Review. Clinical Reviews in Allergy and Immunology, 1-12. https://doi.org/10.1007/s12016-016-8583-2