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AIH.DecompensatedCirrhosis_revMCL.pdf (486.78 KB)

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Document embargat fins el 2026-04-08

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2025-04-08

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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/227590

Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.

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https://doi.org/10.1016/j.cgh.2025.02.010

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Management of patients with autoimmune hepatitis (AIH)-related decompensated cirrhosis is challenging because of the risk of treatment-related complications and lack of clinical recommendations. We investigated the predictive factors for treatment benefit in AIH-related decompensated cirrhosis at diagnosis and developed an algorithm to guide treatment decisions in clinical practice. This retrospective, international, multicenter study included 232 patients with histologically confirmed AIH-related decompensated cirrhosis at diagnosis. The sub-hazard ratio (SHR) of mortality was determined by competing risk analysis, considering liver transplantation (LT) as competing event. A decision tree analysis was used to develop a treatment algorithm. At diagnosis, 89% of patients had ascites and 41% overt hepatic encephalopathy (OHE). Treated patients (n=214, 92%) had higher aminotransferases, bilirubin and modified hepatic activity index. The SHR of mortality was lower in treated patients (0.438, 95%CI 0.196-0.981, p=0.045). Patients without OHE grade 3/4 and MELD-Na ≤28 at diagnosis were more likely to benefit from treatment. In these patients, a decline in MELD-Na ≥11 after 4 weeks of treatment had a 100% negative predictive value for death/LT. Forty-nine percent of treated patients recompensated during follow-up. Twenty percent of patients had to discontinue treatment, 65% during the first 4 weeks, and only 4% due to infectious complications. OHE ≥ grade 2 and MELD-Na at diagnosis predicted the need for treatment discontinuation. Immunosuppression is beneficial in patients with AIH-related decompensated cirrhosis and active disease. OHE and MELD-Na at diagnosis, along with a decline in MELD-Na at 4 weeks of treatment, are the most important determinants of outcome and can guide treatment decisions.

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Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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Arvaniti P, RODRÍGUEZ TAJES, Sergio, Padilla M, Olivas I, MAURO, Ezequiel matías, EL MAIMOUNI, Cautar, Lytvyak E, Verhelst X, Engel B, Taubert R, Lorente-Pérez S, Conde I, Riveiro-Barciela M, Ruiz-Cobo JC, Álvarez-Navascués C, Salcedo M, Gomez J, Janik MK, Mateos B, Efe C, Granito A, Datji E, Azzaroli F, Horta D, Vila C, Castelló I, Pérez-Medrano I, Arencibia A, Gerussi A, Bruns T, Colapierto F, Lleo A, Van den Ende N, Verbeek J, Díaz-Gonzalez A, Morillas RM, Torner-Simó M, Bernal V, Fernández EM, Gevers TJ, LONDOÑO HURTADO, María carlota. Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.. _Clinical Gastroenterology And Hepatology_. 2025. Vol.  S1542-6. [consulta: 28 de febrer de 2026]. ISSN: Arvaniti P; Rodríguez-Tajes S; Padilla M; Olivas I; Mauro E; El Maimouni C; Lytvyak E; Verhelst X; Engel B; Taubert R; Lorente-Pérez S; Conde I; Rivei (2025). Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.. Clinical Gastroenterology And Hepatology, (), S1542-6. DOI: 10.1016/j.cgh.2025.02.010. [Disponible a: https://hdl.handle.net/2445/227590]

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