Autoimmune Hepatitis: Predictors of Native Liver Survival in Children and Adolescents

Autor: Juliana R. Vasconcelos, Jussara Maia, Mariana N. de Paula, Alexandre Rodrigues Ferreira, Marcia A. Valadares, Adriana Porta, Sandra M. Vieira, Themis Reverbel da Silveira, Renata Pugliese, Renata B.P.M. Seixas, Cristina Helena Targa Ferreira, Melina Utz Melere, Jorge Luiz dos Santos, Gilda Porta, Isadora de Carvalho Trevizoli, Vera B. Danesi, Maria Angela Bellomo Brandão, Jorge A. Bezerra, Cibele Dantas Ferreira, Daniela Gois Meneses, Cristian V. Borges, Marise Marsilac, Luciana Rodrigues Silva, Jorge Gama, Eleonora Druve Tavares Fagundes, Elisa de Carvalho, Regina Sawamura, Irene K. Miura
Rok vydání: 2021
Předmět:
Male
Cholagogues and Choleretics
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Cholangitis
Sclerosing
Serum albumin
Autoimmune hepatitis
Liver transplantation
Gastroenterology
Disease course
Leukocyte Count
03 medical and health sciences
0302 clinical medicine
immune system diseases
030225 pediatrics
Internal medicine
medicine
Humans
In patient
Aspartate Aminotransferases
International Normalized Ratio
030212 general & internal medicine
Alanine aminotransferase
Child
Serum Albumin
biology
Platelet Count
business.industry
Medical record
Remission Induction
Ursodeoxycholic Acid
Infant
Female sex
Alanine Transaminase
Complement C3
medicine.disease
digestive system diseases
Liver Transplantation
Hepatitis
Autoimmune
Immunoglobulin M
Child
Preschool
Immunoglobulin G
Pediatrics
Perinatology and Child Health
biology.protein
Female
business
Immunosuppressive Agents
Zdroj: The Journal of Pediatrics. 229:95-101.e3
ISSN: 0022-3476
DOI: 10.1016/j.jpeds.2020.10.009
Popis: To determine predictors of native liver survival (NLS) in children and adolescents with autoimmune hepatitis (AIH).The medical records of children and adolescents with AIH were reviewed. A questionnaire was used to collect data on clinical presentation, biochemical and histologic findings, and treatment.A total of 819 patients were included, 89.6% with AIH-1 and 10.4% with AIH-2. The median age (months) at onset was 108 (min 6; max 210; IQR 59). The female sex was predominant (75.8%). The overall survival was 93.0%, with an NLS of 89.9%; 4.6% underwent liver transplantation. The risk of death or liver transplantation during follow-up was 3.2 times greater in patients with AIH-1 (P = .024). Greater levels of aspartate aminotransferase, alanine aminotransferase, serum albumin, platelet, and normal international normalized ratio at the initial presentation were associated with longer NLS (P = .046, P = .006, P .001, P = .001, and P = .019, respectively). Normal C3 levels was associated with longer NLS (P = .017), with a chance of death or liver transplantation during follow-up being 3.4 times greater in patients with C3 below normal. Death or liver transplantation during follow-up was 2.8 times greater in patients with associated sclerosing cholangitis (P = .046). Complete remission favored NLS (P .001), with a risk of death or liver transplantation 11.7 times greater for patients not achieving remission.The best predictors of NLS in children and adolescents with AIH were the AIH-2 subtype, a normal C3 at diagnosis, remission during treatment, and normal a cholangiogram during the disease course.
Databáze: OpenAIRE
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