000161995 001__ 161995
000161995 005__ 20251017144610.0
000161995 0247_ $$2doi$$a10.1016/j.cgh.2025.02.010
000161995 0248_ $$2sideral$$a144654
000161995 037__ $$aART-2025-144654
000161995 041__ $$aeng
000161995 100__ $$aArvaniti, Pinelopi
000161995 245__ $$aHepatic Encephalopathy and MELD-Na Predict Treatment Benefit in Autoimmune Hepatitis-related Decompensated Cirrhosis
000161995 260__ $$c2025
000161995 5203_ $$aManagement of patients with autoimmune hepatitis (AIH)-related decompensated cirrhosis is challenging because of the risk of treatment-related complications and lack of clinical recommendations. We investigated the predictive factors for treatment benefit in AIH-related decompensated cirrhosis at diagnosis and developed an algorithm to guide treatment decisions in clinical practice.
Methods. This retrospective, international, multicenter study included 232 patients with histologically confirmed AIH-related decompensated cirrhosis at diagnosis. The sub-hazard ratio (SHR) of mortality was determined by competing risk analysis, considering liver transplantation (LT) as competing event. A decision tree analysis was used to develop a treatment algorithm.
Results. At diagnosis, 89% of patients had ascites, and 41% had overt hepatic encephalopathy (OHE). Treated patients (n = 214; 92%) had higher aminotransferases, bilirubin, and modified hepatic activity index. The SHR of mortality was lower in treated patients (0.438; 95% confidence interval [CI], 0.196–0.981; P = .045). Patients without OHE grade 3/4 and Model for End-Stage Liver Disease-Sodium (MELD-Na) ≤28 at diagnosis were more likely to benefit from treatment. In these patients, a decline in MELD-Na ≥11 after 4 weeks of treatment had a 100% negative predictive value for death/LT. Forty-nine percent of treated patients recompensated during follow-up. Twenty percent of patients had to discontinue treatment, 65% during the first 4 weeks, and only 4% due to infectious complications. OHE ≥grade 2 and MELD-Na at diagnosis predicted the need for treatment discontinuation.
Conclusions. Immunosuppression is beneficial in patients with AIH-related decompensated cirrhosis and active disease. OHE and MELD-Na at diagnosis, along with a decline in MELD-Na at 4 weeks of treatment, are the most important determinants of outcome and can guide treatment decisions.
000161995 540__ $$9info:eu-repo/semantics/closedAccess$$aAll rights reserved$$uhttp://www.europeana.eu/rights/rr-f/
000161995 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/acceptedVersion
000161995 700__ $$aRodríguez-Tajes, Sergio
000161995 700__ $$aPadilla, Marlene
000161995 700__ $$aOlivas, Ignasi
000161995 700__ $$aMauro, Ezequiel
000161995 700__ $$aEl Maimouni, Cautar
000161995 700__ $$aLytvyak, Ellina
000161995 700__ $$aVerhelst, Xavier
000161995 700__ $$aEngel, Bastian
000161995 700__ $$aTaubert, Richard
000161995 700__ $$0(orcid)0000-0003-4672-8083$$aLorente-Pérez, Sara$$uUniversidad de Zaragoza
000161995 700__ $$aConde, Isabel
000161995 700__ $$aRiveiro-Barciela, Mar
000161995 700__ $$aRuiz-Cobo, Juan-Carlos
000161995 700__ $$aÁlvarez-Navascués, Carmen
000161995 700__ $$aSalcedo, Magdalena
000161995 700__ $$aGómez, Judith
000161995 700__ $$aJanik, Maciej K.
000161995 700__ $$aMateos, Beatriz
000161995 700__ $$aEfe, Cumali
000161995 700__ $$aGranito, Alessandro
000161995 700__ $$aDajti, Elton
000161995 700__ $$aAzzaroli, Francesco
000161995 700__ $$aHorta, Diana
000161995 700__ $$aVila, Carmen
000161995 700__ $$aCastello, Inmaculada
000161995 700__ $$aPérez-Medrano, Indhira
000161995 700__ $$aArencibia, Ana
000161995 700__ $$aGerussi, Alessio
000161995 700__ $$aBruns, Tony
000161995 700__ $$aColaprieto, Francesca
000161995 700__ $$aLleo, Ana
000161995 700__ $$aVan den Ende, Natalie
000161995 700__ $$aVerbeek, Jef
000161995 700__ $$aDíaz-González, Álvaro
000161995 700__ $$aMorillas, Rosa Ma
000161995 700__ $$aTorner-Simó, Maria
000161995 700__ $$aBernal, Vanesa
000161995 700__ $$aFernández, Eva-Maria
000161995 700__ $$aGevers, Tom J.G.
000161995 700__ $$aTerziroli Beretta-Piccoli, Benedetta
000161995 700__ $$aGómez, Elena
000161995 700__ $$aCuenca, Paqui
000161995 700__ $$ade Boer, Ynte S.
000161995 700__ $$aKerkar, Nanda
000161995 700__ $$aAssis, David N.
000161995 700__ $$aLiberal, Rodrigo
000161995 700__ $$aDrenth, Joost P.H.
000161995 700__ $$aTana, Michele M.
000161995 700__ $$aSebode, Marcial
000161995 700__ $$aSchregel, Ida
000161995 700__ $$aSchramm, Christoph
000161995 700__ $$aLohse, Ansgar W.
000161995 700__ $$aMontano-Loza, Aldo J.
000161995 700__ $$aZachou, Kalliopi
000161995 700__ $$aVillamil, Alejandra
000161995 700__ $$aDalekos, George N.
000161995 700__ $$aLondoño, María-Carlota
000161995 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000161995 773__ $$g(2025), 19 pp.$$pClin Gastroenterol Hepatol$$tClinical Gastroenterology and Hepatology$$x1542-3565
000161995 8564_ $$s2006870$$uhttps://zaguan.unizar.es/record/161995/files/texto_completo.pdf$$yPostprint
000161995 8564_ $$s3241079$$uhttps://zaguan.unizar.es/record/161995/files/texto_completo.jpg?subformat=icon$$xicon$$yPostprint
000161995 909CO $$ooai:zaguan.unizar.es:161995$$particulos$$pdriver
000161995 951__ $$a2025-10-17-14:16:56
000161995 980__ $$aARTICLE