Analysis of clinical features and prognosis of acute severe autoimmune hepatitis / 中华肝脏病杂志

Objective: To analyze the clinical features and prognosis of acute severe autoimmune hepatitis (AIH). Methods: A retrospective analysis of the clinical data of patients with acute severe AIH admitted to our hospital from 2008 to 2019 was divided into acute AIH (A-AIH) and chronic acute AIH (AC-AIH) according to the presence or absence of liver diseases. Patients' general condition, liver biochemistry, immunology, histological features of liver, hormonal therapies prognosis and related factors were analyzed. Results: A total of 41 cases [39 females, age (54.24 ± 10.55) years] were collected. Alanine aminotransferase (ALT) and total bilirubin (TBil) were significantly increased, and the international normalized ratio (INR) was > 1.5. Acute lobular inflammation was the feature of acute and severe AIH in the histology of liver. The serum IgG level was (28.36 ± 8.35) g / L. The positive rate of antinuclear antibody (ANA) and anti-smooth muscle antibody (ASMA) was 82.9%, and 17.1%, respectively. Over 70% of acute severe AIHs were AC-AIH. The duration of onset of AC-AIH was > 8 weeks, while most A-AIHs < 8 weeks, and the differences between the two groups were statistically significant (P = 0.001). The mortality rate within 30 days after hormonal treatment was 19.5%. There were statistically significant differences in TBil, Model for End-Stage Liver Disease (MELD) score and leukocyte count between the death and survival group. Conclusion: The mortality rate in acute severe AIH is high, and most of them have the basis of chronic liver disease. Serum IgG level, autoantibodies and acute lobular inflammation are important factors for diagnosis. The prognosis of hormonal therapy is related to the patients' condition and course of disease.

Model for end-stage liver disease can predicte short-term prognosis of patients with sub-acute severe hepatitis / 重庆医科大学学报

Objective:To evaluate the value ofmodel for end-stage liver disease(MELD)score for predictivingthe short-term prognosis of the sub-acute severe hepatitis.Methods:A total of 73 patients with sub-acute severe hepatitis were enrolled in this study.The information of first day admitted to the hospital was used to calculate MELD score.We used ROC curves and area under the curve to evaluate its prognostic value.Results:A total of 32 patients died(43.8%)in 3 months,which have higher MELE score than the survival of patients(t=3.125,P=0.002).The area under the curve for predicting prognosis was 0.756(P=0.000 1),95%CI[0.646～0.866]. When the cutoff value was 26,the predicted sensitivity was 0.906,the specificity was 0.854,and the accuracy was 0.877.Conclusion: Model for end-stage liver disease has a good predicting value of short-term prognosis for patients with sub-acute severe viral hepatitis.