Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.

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 di...

ver descrição completa

Detalhes bibliográficos
Autores: Arvaniti, Pinelopi, Rodríguez Tajes, Sergio, Olivas Alberch, Ignasi, Mauro, Ezequiel Matías, Maimouni, Cautar el, Londoño Hurtado, María Carlota, International Autoimmune Hepatitis Group (IAIHG), European Reference Network on Hepatological Diseases (ENR RARE-LIVER), Spanish Registry for Autoimmune and Cholestatic Diseases (ColHai)
Formato: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2025
País:España
Recursos:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/227590
Acesso em linha:https://hdl.handle.net/2445/227590
Access Level:acceso abierto
Palavra-chave:Cirrosi hepàtica
Insuficiència hepàtica
Trasplantament hepàtic
Hepatic cirrhosis
Liver failure
Hepatic transplantation
id ES_b26daaa90a477c717a81d33c729c24ef
oai_identifier_str oai:recercat.cat:2445/227590
network_acronym_str ES
network_name_str España
repository_id_str
spelling Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.Arvaniti, PinelopiRodríguez Tajes, SergioOlivas Alberch, IgnasiMauro, Ezequiel MatíasMaimouni, Cautar elLondoño Hurtado, María CarlotaInternational Autoimmune Hepatitis Group (IAIHG)European Reference Network on Hepatological Diseases (ENR RARE-LIVER)Spanish Registry for Autoimmune and Cholestatic Diseases (ColHai)Cirrosi hepàticaInsuficiència hepàticaTrasplantament hepàticHepatic cirrhosisLiver failureHepatic transplantationManagement 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. 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. At diagnosis, 89% of patients had ascites and 41% 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%CI 0.196-0.981, p=0.045). Patients without OHE grade 3/4 and 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. 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.2026202620252026info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfhttps://hdl.handle.net/2445/227590Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésVersió postprint publicada a: https://doi.org/10.1016/j.cgh.2025.02.010Clinical Gastroenterology And Hepatology, 2025https://doi.org/10.1016/j.cgh.2025.02.010(c) AGA Institute, 2025info:eu-repo/semantics/openAccessoai:recercat.cat:2445/2275902026-05-29T05:05:01Z
dc.title.none.fl_str_mv Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.
title Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.
spellingShingle Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.
Arvaniti, Pinelopi
Cirrosi hepàtica
Insuficiència hepàtica
Trasplantament hepàtic
Hepatic cirrhosis
Liver failure
Hepatic transplantation
title_short Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.
title_full Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.
title_fullStr Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.
title_full_unstemmed Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.
title_sort Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis.
dc.creator.none.fl_str_mv Arvaniti, Pinelopi
Rodríguez Tajes, Sergio
Olivas Alberch, Ignasi
Mauro, Ezequiel Matías
Maimouni, Cautar el
Londoño Hurtado, María Carlota
International Autoimmune Hepatitis Group (IAIHG)
European Reference Network on Hepatological Diseases (ENR RARE-LIVER)
Spanish Registry for Autoimmune and Cholestatic Diseases (ColHai)
author Arvaniti, Pinelopi
author_facet Arvaniti, Pinelopi
Rodríguez Tajes, Sergio
Olivas Alberch, Ignasi
Mauro, Ezequiel Matías
Maimouni, Cautar el
Londoño Hurtado, María Carlota
International Autoimmune Hepatitis Group (IAIHG)
European Reference Network on Hepatological Diseases (ENR RARE-LIVER)
Spanish Registry for Autoimmune and Cholestatic Diseases (ColHai)
author_role author
author2 Rodríguez Tajes, Sergio
Olivas Alberch, Ignasi
Mauro, Ezequiel Matías
Maimouni, Cautar el
Londoño Hurtado, María Carlota
International Autoimmune Hepatitis Group (IAIHG)
European Reference Network on Hepatological Diseases (ENR RARE-LIVER)
Spanish Registry for Autoimmune and Cholestatic Diseases (ColHai)
author2_role author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Cirrosi hepàtica
Insuficiència hepàtica
Trasplantament hepàtic
Hepatic cirrhosis
Liver failure
Hepatic transplantation
topic Cirrosi hepàtica
Insuficiència hepàtica
Trasplantament hepàtic
Hepatic cirrhosis
Liver failure
Hepatic transplantation
description 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. 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. At diagnosis, 89% of patients had ascites and 41% 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%CI 0.196-0.981, p=0.045). Patients without OHE grade 3/4 and 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. 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.
publishDate 2025
dc.date.none.fl_str_mv 2025
2026
2026
2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/227590
url https://hdl.handle.net/2445/227590
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Versió postprint publicada a: https://doi.org/10.1016/j.cgh.2025.02.010
Clinical Gastroenterology And Hepatology, 2025
https://doi.org/10.1016/j.cgh.2025.02.010
dc.rights.none.fl_str_mv (c) AGA Institute, 2025
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) AGA Institute, 2025
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869417053723557888
score 15,811543

Registos relacionados