Clinical Characteristics of Genuine Acute Autoimmune Hepatitis.

Autor:	Oliveira EMG; Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.; Centro Universitário Lusíada, Santos, Brazil., Amaral ACC; Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil., Oliveira PMC; Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil., Lanzoni VP; Department of Pathology, Federal University of Sao Paulo, Sao Paulo, Brazil., Perez RM; Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil., Narciso-Schiavon JL; Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, Brazil., Whale RC; Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil., Carvalho-Filho RJ; Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil., Silva AEB; Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil., Ferraz MLCG; Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	GE Portuguese journal of gastroenterology [GE Port J Gastroenterol] 2023 Jul 12; Vol. 31 (3), pp. 173-181. Date of Electronic Publication: 2023 Jul 12 (Print Publication: 2024).
DOI:	10.1159/000531018
Abstrakt:	Introduction: Autoimmune hepatitis (AIH) has a spectrum of symptoms ranging from asymptomatic disease to acute severe hepatitis, chronic hepatitis, and decompensated cirrhosis. The acute presentation is not rare and could represent genuine acute AIH (GAAIH) or acute exacerbation of chronic autoimmune hepatitis. We aimed to identify the prevalence, clinical features, and prognostic factors associated with GAAIH and compare these cases with acute exacerbation of chronic AIH. Methods: This cross-sectional observational study evaluated patients with acute AIH presentation, defined as total bilirubin >5 times the upper limit of normality (xULN) and/or alanine aminotransferase >10 xULN, and no prior history of liver disease. Histology findings of acute disease defined GAAIH. Bivariate analyses were performed to identify factors associated with the GAAIH, when compared with acute exacerbation of chronic AIH. Results: Seventy-two patients with acute presentation of AIH were included and six (8.3%) of them presented GAAIH. Comparative analysis between patients with GAAIH and patients with acute exacerbation of chronic AIH revealed that prothrombin activity (96% [74-100] vs. 61% [10-100]; p = 0.003) and albumin levels (3.9 ± 0.2 g/dL vs. 3.4 ± 0.5 g/dL; p < 0.001) were higher in patients with GAAIH. The International Autoimmune Hepatitis Group score was higher in patients with acute exacerbation of chronic AIH (18.5 [8-23] vs. 16.5 [15-17]; p = 0.010). Compared to 15.2% of acute exacerbation of chronic AIH, complete therapeutic response to treatment was achieved in 67.7% of cases with GAAIH ( p = 0.018). Conclusions: GAAIH was rare (8.3%), and patients with this presentation exhibited more preserved liver function tests, suggesting that most cases presenting with loss of function are acute exacerbation of chronic AIH. Additionally, patients with GAAIH had a better complete therapeutic response, suggesting a more preserved liver function at presentation, and early diagnosis has a positive therapeutic implication. Competing Interests: The authors have no conflicts of interest to declare. (© 2023 The Author(s).Published by S. Karger AG, Basel.)
Databáze:	MEDLINE
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