دورية أكاديمية
Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study.
| العنوان: | Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study. |
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| المؤلفون: | Téllez, Luis, Sánchez Rodríguez, Eugenia, Rodríguez de Santiago, Enrique, Llovet, Laura, Gómez-Outomuro, Ana, Díaz-Fontenla, Fernando, Álvarez López, Patricia, García-Eliz, María, Amaral, Carla, Sánchez-Torrijos, Yolanda, Fortea, José Ignacio, Ferre-Aracil, Carlos, Rodríguez-Perálvarez, Manuel, Abadía, Marta, Gómez-Camarero, Judith, Olveira, Antonio, Calleja, José Luis, Crespo, Javier, Romero, Manuel, Hernández-Guerra, Manuel, Berenguer, Marina, Riveiro-Barciela, Mar, Salcedo, Magdalena, Rodríguez, Manuel, Londoño, María Carlota, Albillos, Agustín |
| سنة النشر: | 2022 |
| المجموعة: | Sistema Sanitario Público de Andalucía (SSPA): Repositorio |
| مصطلحات موضوعية: | Acute Disease, Adolescent, Adrenal Cortex Hormones, Ascites, Brain Diseases, Hepatitis, Autoimmune, Humans, Prognosis, Retrospective Studies, Severity of Illness Index |
| الوصف: | 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. 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. 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). 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. |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 1365-2036 |
| العلاقة: | http://hdl.handle.net/10668/19913Test; PMC9324977; https://repositorio.uam.es/bitstream/10486/705454/2/early_tellez_ap%26t_2022.pdfTest; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9324977/pdfTest |
| DOI: | 10.1111/apt.16926 |
| الإتاحة: | https://doi.org/10.1111/apt.16926Test http://hdl.handle.net/10668/19913Test https://repositorio.uam.es/bitstream/10486/705454/2/early_tellez_ap%26t_2022.pdfTest https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9324977/pdfTest |
| حقوق: | Attribution-NonCommercial 4.0 International ; http://creativecommons.org/licenses/by-nc/4.0Test/ ; open access |
| رقم الانضمام: | edsbas.3EA4CACC |
| قاعدة البيانات: | BASE |
Full Text Finder | تدمد: | 13652036 |
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| DOI: | 10.1111/apt.16926 |