Hepatic Encephalopathy and MELD-Na Predict Treatment Benefit in Autoimmune Hepatitis-related Decompensated Cirrhosis

Arvaniti, Pinelopi ; Rodríguez-Tajes, Sergio ; Padilla, Marlene ; Olivas, Ignasi ; Mauro, Ezequiel ; El Maimouni, Cautar ; Lytvyak, Ellina ; Verhelst, Xavier ; Engel, Bastian ; Taubert, Richard ; Lorente-Pérez, Sara (Universidad de Zaragoza) ; Conde, Isabel ; Riveiro-Barciela, Mar ; Ruiz-Cobo, Juan-Carlos ; Álvarez-Navascués, Carmen ; Salcedo, Magdalena ; Gómez, Judith ; Janik, Maciej K. ; Mateos, Beatriz ; Efe, Cumali ; Granito, Alessandro ; Dajti, Elton ; Azzaroli, Francesco ; Horta, Diana ; Vila, Carmen ; Castello, Inmaculada ; Pérez-Medrano, Indhira ; Arencibia, Ana ; Gerussi, Alessio ; Bruns, Tony ; Colaprieto, Francesca ; Lleo, Ana ; Van den Ende, Natalie ; Verbeek, Jef ; Díaz-González, Álvaro ; Morillas, Rosa Ma ; Torner-Simó, Maria ; Bernal, Vanesa ; Fernández, Eva-Maria ; Gevers, Tom J.G. ; Terziroli Beretta-Piccoli, Benedetta ; Gómez, Elena ; Cuenca, Paqui ; de Boer, Ynte S. ; Kerkar, Nanda ; Assis, David N. ; Liberal, Rodrigo ; Drenth, Joost P.H. ; Tana, Michele M. ; Sebode, Marcial ; Schregel, Ida ; Schramm, Christoph ; Lohse, Ansgar W. ; Montano-Loza, Aldo J. ; Zachou, Kalliopi ; Villamil, Alejandra ; Dalekos, George N. ; Londoño, María-Carlota

Resumen: Management 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.

Idioma: Inglés

DOI: 10.1016/j.cgh.2025.02.010

Año: 2025

Publicado en: Clinical Gastroenterology and Hepatology (2025), 19 pp.
ISSN: 1542-3565

Tipo y forma: Article (PostPrint)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)