The creation of an autoimmune hepatitis register and a nurse-led service: A worthy lock-down pastime

ABSTRACT

Introduction Autoimmune Hepatitis (AIH) is a relapsing chronic inflammatory condition1 that waxes and wanes irrespective of outpatient clinic scheduling. York Teaching Hospital NHS Foundation Trust (YTHT) covers a wide geographical area.2 The COVID-19 pandemic has demonstrated that not all patients require regular clinical review in person. Aim To update the clinical registry of AIH patients within YTHT, ensuring appropriate monitoring during Covid-19, and prompt review for those requiring it. Methods An IT-based search identified individuals' with a diagnosis of AIH within YTHT. An electronic note review established demographic details, risk factors for co-existing liver disease, severity of AIH, disease treatment, and current blood results. Results 128 patients were identified, 81% of whom were female. The average age was 68 years (range 17-88). 51% were local to York Hospital and 34% closer to Scarborough Hospital, as demonstrated in figure 1. The remainder travel to their closest hub. 55% of the cohort had an elevated ALT suggesting ongoing disease activity (arguably ALT >31UI/L in males and ALT >21 UI/L in females). 62% were taking significant immunosuppression;Azathioprine 32%, Mycophenolate Mofetil 14.4%, Tacrolimus 9.6% and Prednisolone >20 mg/ day 6.4%. Discussion The COVID-19 pandemic has demonstrated the need to identify and offer timely follow-up for our most unwell patients, allowing those with a stable condition to safely shield. Virtual monitoring of patients is important to identify asymptomatic flares. We advocate incorporating nurseled monitoring of such patients, in combination with patient initiated follow-up for those with symptomatic disease.