Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study

Autor: Luis Téllez, Eugenia Sánchez Rodríguez, Enrique Rodríguez de Santiago, Laura Llovet, Ana Gómez‐Outomuro, Fernando Díaz‐Fontenla, Patricia Álvarez López, María García‐Eliz, Carla Amaral, Yolanda Sánchez‐Torrijos, José Ignacio Fortea, Carlos Ferre‐Aracil, Manuel Rodríguez‐Perálvarez, Marta Abadía, Judith Gómez‐Camarero, Antonio Olveira, José Luis Calleja, Javier Crespo, Manuel Romero, Manuel Hernández‐Guerra, Marina Berenguer, Mar Riveiro‐Barciela, Magdalena Salcedo, Manuel Rodríguez, María Carlota Londoño, Agustín Albillos, Ignacio Omella, María Trapero, Francisco Gea, Carmen Alvarez‐Navascués, María‐Luisa González‐Diéguez, Manuel Romero‐Gómez
Přispěvatelé: Universidad de Cantabria, UAM. Departamento de Medicina, Institut Català de la Salut, [Téllez L, Sánchez Rodríguez E, Rodríguez de Santiago E] Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Universidad de Alcalá, Madrid, Spain. [Llovet L] Liver Unit, Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Universidad de Barcelona, Barcelona, Spain. [Gómez-Outomuro A] Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, ISPA, Universidad de Oviedo, Oviedo, Spain. [Díaz-Fontenla F] Liver Unit, Hospital General Universitario Gregorio Marañón, IISGM. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Universidad Complutense de Madrid, Madrid, Spain. [Álvarez López P, Riveiro-Barciela M] Unitat Hepàtica, Servei de Medicina Interna, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Universidad de Barcelona, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus
Rok vydání: 2021
Předmět:
Adolescent
Medicina
FEATURES
Corticosteroides - Ús terapèutic
DIAGNOSIS
THERAPY
Severity of Illness Index
Adrenal Cortex Hormones
hormonas
sustitutos de hormonas y antagonistas de hormonas::hormonas::hormonas de la corteza suprarrenal [COMPUESTOS QUÍMICOS Y DROGAS]
CRITERIA
Humans
Pharmacology (medical)
Other subheadings::/therapeutic use [Other subheadings]
Diagnosis::Prognosis [ANALYTICAL
DIAGNOSTIC AND THERAPEUTIC TECHNIQUES
AND EQUIPMENT]
diagnóstico::pronóstico [TÉCNICAS Y EQUIPOS ANALÍTICOS
DIAGNÓSTICOS Y TERAPÉUTICOS]
Retrospective Studies
Brain Diseases
Hormones
Hormone Substitutes
and Hormone Antagonists::Hormones::Adrenal Cortex Hormones [CHEMICALS AND DRUGS]
Hepatology
Otros calificadores::/uso terapéutico [Otros calificadores]
enfermedades del sistema digestivo::enfermedades hepáticas::hepatitis::hepatitis crónica::hepatitis autoinmune [ENFERMEDADES]
Gastroenterology
Ascites
LIVER-TRANSPLANTATION
Prognosis
FUNGAL-INFECTION
MODEL
Hepatitis crònica activa - Prognosi
Hepatitis
Autoimmune
Corticosteroid
autoimmune hepatitis
Acute Disease
Digestive System Diseases::Liver Diseases::Hepatitis::Hepatitis
Chronic::Hepatitis
Autoimmune [DISEASES]
Zdroj: ALIMENTARY PHARMACOLOGY & THERAPEUTICS
r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe
instname
Aliment Pharmacol Ther . 2022 Jul;56(1):131-143
Scientia
ISSN: 1365-2036
0269-2813
Popis: Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAM
To assess whether corticosteroids improve prognosis in patients with AS-AIH, and to identify factors at therapy initiation and during therapy predictive of the response to corticosteroids. Methods: This was a retrospective cohort study including all patients with AS-AIH admitted to 13 tertiary centres from January 2002 to January 2019. The composite primary outcome was death or liver transplantation within 90 days of admission. Kaplan–Meier and Cox regression methods were used for data analysis. Results: Of 242 consecutive patients enrolled (mean age [SD] 49.7 [16.8] years), 203 received corticosteroids. Overall 90-day transplant-free survival was 61.6% (95% confidence interval [CI] 55.4–67.7). Corticosteroids reduced the risk of a poor outcome (adjusted hazard ratio [HR] 0.25; 95% CI 0.2–0.4), but this treatment failed in 30.5%. An internally validated nomogram composed of older age, MELD, encephalopathy and ascites at the initiation of corticosteroids accurately predicted the response (C-index 0.82; [95% CI 0.8–0.9]). In responders, MELD significantly improved from days 3 to 14 but remained unchanged in non-responders. MELD on day 7 with a cut-off of 25 (sensitivity 62.5%[95% CI: 47.0–75.8]; specificity 95.2% [95% CI: 89.9–97.8]) was the best univariate predictor of the response. Prolonging corticosteroids did not increase the overall infection risk (adjusted HR 0.75; 95% CI 0.3–2.1). Conclusion: Older patients with high MELD, encephalopathy or ascites at steroid therapy initiation and during treatment are unlikely to show a favourable response and so prolonged therapy in these patients, especially if they are transplantation candidates, should be avoided
This study was supported in part by grants from the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III, number PI20/01302, awarded to Agustín Albillos and number PI 21/01310, awarded to Luis Téllez. CIBEREHD is funded by the Instituto de Salud Carlos III using grants cofinanced by the European Development Regional Fund “A way to achieve Europe” (EDRF). María Carlota Londoño received support from the Plan Nacional de I+D+I co- funded by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER-"Una manera de Hacer Europa") (PI17/00955)
Databáze: OpenAIRE
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