Autoimmune hepatitis: Effect of symptoms and cirrhosis on natural history and outcome

Abstract

Although the natural history of autoimmune hepatitis (AIH) has been characterized, little is known about patients who present asymptomatically. Consequently, whether they require immunosuppressive therapy with its associated complications is unclear. To compare the natural history of asymptomatic AIH with symptomatic AIH, a large cohort of patients from a single center was examined. All patients with a clinical diagnosis of AIH were reassessed using the revised criteria of the International Autoimmune Hepatitis Group. Liver histology, response to therapy, and survival were assessed. Patients asymptomatic at presentation (n ‫؍‬ 31) had lower serum aminotransferase, bilirubin, and immunoglobulin G (IgG) values at baseline. Half of the asymptomatic patients received no therapy, and their survival was no different from that of the total cohort. Ten-year survival was 80.0% (62.5%-97.5%) in the asymptomatic group and 83.8% (75.1%-92.6%) in the symptomatic patients (P ‫؍‬ NS). Survival to liver-related endpoints at 10 years was similar in both groups: 89.5% (

Autoimmune hepatitis: new paradigms in the pathogenesis, diagnosis, and management

“…The presence of cirrhosis at the time of presentation has also been associated with an adverse prognosis [18].…”

“…They revealed that untreated AIH has a poor prognosis with 5-and 10-year survival rates of 50 and 10%, respectively, whereas treatment with prednisolone is associated with excellent short-and long-term survival [34,35]. Up to 30% of adult patients have histological features of cirrhosis at diagnosis [18,36] and progression of fibrosis can occur in patients with inflammatory activity despite steroid therapy [18]. The presence of cirrhosis at baseline significantly increases the risk of subsequent death or liver transplantation [18,37].…”

“…Up to 30% of adult patients have histological features of cirrhosis at diagnosis [18,36] and progression of fibrosis can occur in patients with inflammatory activity despite steroid therapy [18]. The presence of cirrhosis at baseline significantly increases the risk of subsequent death or liver transplantation [18,37]. The risk of hepatocellular carcinoma (HCC) in autoimmune liver disease is associated with the development of cirrhosis and is no greater than in other non-viral causes of cirrhosis [38].…”

“…The risk of hepatocellular carcinoma (HCC) in autoimmune liver disease is associated with the development of cirrhosis and is no greater than in other non-viral causes of cirrhosis [38]. The 10-year overall survival of patients with AIH ranges between 80 and 93% [18]. The increasing diagnosis of AIH on routine blood testing, particularly in the elderly, has uncovered a group of patients with asymptomatic AIH who appear to have a very indolent course.…”

Hepatitis autoinmune precedida por infección aguda por citomegalovirus en una mujer inmunocompetente

“…Los autoanticuerpos no tienen papel en la monitorización. La presencia de cirrosis es el principal factor de mal pronóstico 12 .…”