Baseline Predictors of the Long-Term Insufficient Biochemical Response in Patients with Autoimmune Hepatitis: A Single Center Experience
The treatment response criteria in autoimmune hepatitis (AIH) have been recently updated. This study aimed to assess treatment responses in 39 (16 males) patients with AIH confirmed by histology. Prednisone added to azathioprine or mycophenolate was the most frequent first-line treatment. Serum alan...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/8/3008 |
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| author | Pierluigi Toniutto Michela Zorzi Lorenzo D’Alì Annarosa Cussigh Sara Cmet Davide Bitetto Ezio Fornasiere Elisa Fumolo Carla Di Loreto Edmondo Falleti |
| author_facet | Pierluigi Toniutto Michela Zorzi Lorenzo D’Alì Annarosa Cussigh Sara Cmet Davide Bitetto Ezio Fornasiere Elisa Fumolo Carla Di Loreto Edmondo Falleti |
| author_sort | Pierluigi Toniutto |
| collection | DOAJ |
| description | The treatment response criteria in autoimmune hepatitis (AIH) have been recently updated. This study aimed to assess treatment responses in 39 (16 males) patients with AIH confirmed by histology. Prednisone added to azathioprine or mycophenolate was the most frequent first-line treatment. Serum alanine aminotransferase (ALT) levels were periodically checked for a median of 45 months. Eight (20.5%) patients presented 4 weeks non-response (NR). Baseline lower multiples of ALT above the upper normal limit (UNL) (<i>p</i> = 0.005), Ishak liver fibrosis score > 3 (<i>p</i> = 0.029), and less frequent confluent necrosis > 2 (<i>p</i> < 0.001) were independent predictors of NR. 24 (61.5%) patients achieved complete biochemical response (CBR) at six months. Ishak liver fibrosis score ≤ 3 (<i>p</i> < 0.001), lobular eosinophilic infiltrate (<i>p</i> < 0.001), and ≥50% decrease in serum ALT levels at week 4 (<i>p</i> < 0.001) were independent predictors of CBR. In addition, the GLUCRE score, derived from the multiplication of serum creatinine (mg/dL) and glucose (mg/dL) levels, were identified. A baseline GLUCRE value > 100 strongly predicted CBR failure (<i>p</i> = 0.003) at a follow-up greater than 12 months. In conclusion, the absence of cirrhosis and a ≥50% UNL decrease in serum ALT levels were independent predictors for CBR. A baseline GLUCRE score may help identify patients maintaining longer CBR. |
| first_indexed | 2024-03-11T04:53:25Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T04:53:25Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-da856fd4a42f40018622b261ec2a2ee02023-11-17T19:51:35ZengMDPI AGJournal of Clinical Medicine2077-03832023-04-01128300810.3390/jcm12083008Baseline Predictors of the Long-Term Insufficient Biochemical Response in Patients with Autoimmune Hepatitis: A Single Center ExperiencePierluigi Toniutto0Michela Zorzi1Lorenzo D’Alì2Annarosa Cussigh3Sara Cmet4Davide Bitetto5Ezio Fornasiere6Elisa Fumolo7Carla Di Loreto8Edmondo Falleti9Hepatology and Liver Transplantation Unit, Department of Specialized Medicine, Udine University Hospital, 33100 Udine, ItalyHepatology and Liver Transplantation Unit, Department of Specialized Medicine, Udine University Hospital, 33100 Udine, ItalyDepartment of Medicine, Institute of Pathological Anatomy, Udine University Hospital, 33100 Udine, ItalyClinical Pathology, Udine University Hospital, 33100 Udine, ItalyClinical Pathology, Udine University Hospital, 33100 Udine, ItalyHepatology and Liver Transplantation Unit, Department of Specialized Medicine, Udine University Hospital, 33100 Udine, ItalyHepatology and Liver Transplantation Unit, Department of Specialized Medicine, Udine University Hospital, 33100 Udine, ItalyHepatology and Liver Transplantation Unit, Department of Specialized Medicine, Udine University Hospital, 33100 Udine, ItalyDepartment of Medicine, Institute of Pathological Anatomy, Udine University Hospital, 33100 Udine, ItalyHepatology and Liver Transplantation Unit, Department of Specialized Medicine, Udine University Hospital, 33100 Udine, ItalyThe treatment response criteria in autoimmune hepatitis (AIH) have been recently updated. This study aimed to assess treatment responses in 39 (16 males) patients with AIH confirmed by histology. Prednisone added to azathioprine or mycophenolate was the most frequent first-line treatment. Serum alanine aminotransferase (ALT) levels were periodically checked for a median of 45 months. Eight (20.5%) patients presented 4 weeks non-response (NR). Baseline lower multiples of ALT above the upper normal limit (UNL) (<i>p</i> = 0.005), Ishak liver fibrosis score > 3 (<i>p</i> = 0.029), and less frequent confluent necrosis > 2 (<i>p</i> < 0.001) were independent predictors of NR. 24 (61.5%) patients achieved complete biochemical response (CBR) at six months. Ishak liver fibrosis score ≤ 3 (<i>p</i> < 0.001), lobular eosinophilic infiltrate (<i>p</i> < 0.001), and ≥50% decrease in serum ALT levels at week 4 (<i>p</i> < 0.001) were independent predictors of CBR. In addition, the GLUCRE score, derived from the multiplication of serum creatinine (mg/dL) and glucose (mg/dL) levels, were identified. A baseline GLUCRE value > 100 strongly predicted CBR failure (<i>p</i> = 0.003) at a follow-up greater than 12 months. In conclusion, the absence of cirrhosis and a ≥50% UNL decrease in serum ALT levels were independent predictors for CBR. A baseline GLUCRE score may help identify patients maintaining longer CBR.https://www.mdpi.com/2077-0383/12/8/3008autoimmune hepatitisazathioprinecomplete biochemical responseliver cirrhosis |
| spellingShingle | Pierluigi Toniutto Michela Zorzi Lorenzo D’Alì Annarosa Cussigh Sara Cmet Davide Bitetto Ezio Fornasiere Elisa Fumolo Carla Di Loreto Edmondo Falleti Baseline Predictors of the Long-Term Insufficient Biochemical Response in Patients with Autoimmune Hepatitis: A Single Center Experience Journal of Clinical Medicine autoimmune hepatitis azathioprine complete biochemical response liver cirrhosis |
| title | Baseline Predictors of the Long-Term Insufficient Biochemical Response in Patients with Autoimmune Hepatitis: A Single Center Experience |
| title_full | Baseline Predictors of the Long-Term Insufficient Biochemical Response in Patients with Autoimmune Hepatitis: A Single Center Experience |
| title_fullStr | Baseline Predictors of the Long-Term Insufficient Biochemical Response in Patients with Autoimmune Hepatitis: A Single Center Experience |
| title_full_unstemmed | Baseline Predictors of the Long-Term Insufficient Biochemical Response in Patients with Autoimmune Hepatitis: A Single Center Experience |
| title_short | Baseline Predictors of the Long-Term Insufficient Biochemical Response in Patients with Autoimmune Hepatitis: A Single Center Experience |
| title_sort | baseline predictors of the long term insufficient biochemical response in patients with autoimmune hepatitis a single center experience |
| topic | autoimmune hepatitis azathioprine complete biochemical response liver cirrhosis |
| url | https://www.mdpi.com/2077-0383/12/8/3008 |
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