Early liver transplantation for corticosteroid non-responders with acute severe autoimmune hepatitis: The SURFASA score

Validation of the SURFASA score to define steroid responsiveness in patients with acute autoimmune hepatitis

“…In our cohort, the best cut-off value of SURFASA was -2.35, which was significantly lower than reported in the study by Martin et al [1] (Table 1b). Based on the published thresholds [1], which were -0.9 and 1.75, the SURFASA score could not discriminate survivors from J o u r n a l P r e -p r o o f non-survivors (Table 1b).…”

“…In our cohort, the best cut-off value of SURFASA was -2.35, which was significantly lower than reported in the study by Martin et al [1] (Table 1b). Based on the published thresholds [1], which were -0.9 and 1.75, the SURFASA score could not discriminate survivors from J o u r n a l P r e -p r o o f non-survivors (Table 1b). When the threshold was lowered to -2.35, the survival rate was 100% in the patients with SURFASA score <=-2.35; 77.8% of those with SURFASA>-2.35 died or received liver transplantation.…”

“…Rajiv Jalan is an inventor of ornithine phenylacetate, which was licensed by UCL to Mallinckrodt. He is also the inventor of Yaq-001, DIALIVE and Yaq-005, the patents for which have been licensed by his University into a UCL spinout company, Yaqrit Ltd. We read with interest the paper of De Martin and colleagues [1], in which they developed a novel scoring system to predict corticosteroid response in patients with severe acute autoimmune hepatitis (AIH). The SURFASA score comprised three parameters, the baseline INR, change in INR over 3-days and change in total bilirubin over 3-days after initiation of steroids.…”

Reply to: “Acute severe autoimmune hepatitis – timing for steroids and role of other immunosuppressive agents”

“…We would like to thank Liberal et al for their interest in our recently published paper 1 and their very interesting comments. 2 Concerning the modalities for corticosteroid administration, we agree with the authors that they need to be personalized.…”

Acute severe autoimmune hepatitis – timing for steroids and role of other immunosuppressive agents

“…In the current study prednisone or prednisolone was administered in variable doses, although no differences were found between patients receiving a higher or a lower dose of steroids. 1 In another recently published study, comprising a less severe cohort of patients, a high response rate following administration of intravenous steroids was reported. 3 Although the choice of dose and route of steroids should be personalised, we suspect that in the appropriately selected individual, oral corticosteroids should suffice, and should most likely be the standard of care.…”