P-40 SEVERE AUTOIMMUNE HEPATITIS: CORTICOSTEROID THERAPY OR EARLY ENROLLMENT TO LIVER TRANSPLANTATION

• Main Authors: Andrea Jiménez, Alan Poniachik, Eladio González, Andrés De la Vega, Máximo Cattaneo, Juan Pablo Roblero, Jaime Poniachik, Alvaro Urzúa
• Format: Article
• Language: English
• Published: Elsevier 2021-09-01
• Series: Annals of Hepatology
• Online Access: http://www.sciencedirect.com/science/article/pii/S1665268121001034

Introduction: Autoimmune hepatitis can present in severe or fulminant acute form (SAH). Only 30-60% of these patients respond favorably to corticosteroids. There is no clarity on its indication and how to evaluate steroid therapy in SAH. Objectives: To evaluate the early response to corticosteroid treatment in patients with SAH (defined as bilirubin> 10 mg / dL or hepatic encephalopathy). Method: Retrospective study of 27 patients with SAH, who received corticosteroids, aged 44 years (20-74), 19 (70%) women. Non-responder (NR) was defined if the patient died or required liver transplantation. Results: 8 patients (30%) were NR, age 49 years (21-72). Bilirubin 22.7 (15-43), INR 2.52 (1.7-3.1), MELD-Na 31 (23-38), UKELD 64 (58-66). Responders (R): 19 (70 %), age 46 years (20 -74). Bilirubin 16 (10-32), INR 1.6 (1-2.8), MELD-Na 23 (17-30), UKELD 59 (54-62). The control at 3 days of R vs NR respectively was bilirubin 10.6 vs 20.3, MELD-Na 19 vs 31, (p <0.001). The Lille in the R at 3, 7 and 14 days had a statistically significant difference with respect to the NR (p <0.005). Conclusion: The majority of SAH patients (70%) respond to steroid therapy. The favorable response at 3 days could be used as a therapeutic guide. The Lille score was a good predictor on the third day after starting corticosteroids. There was no additional benefit when applying it at 7 and 14 days. MELD-Na is a good predictor of evolution.