Autor(es): João, Mafalda ; Carvalhana, Sofia ; Moura, Miguel ; Freitas, Luís Carlos ; Silva, Andrea ; Figueiredo, Pedro ; Liberal, Rodrigo ; Macedo, Guilherme ; Cardoso, Filipe ; Pinto-Marques, Hugo ; Marinho, Rui ; Cortez-Pinto, Helena
Data: 2022
Identificador Persistente: http://hdl.handle.net/10451/56329
Origem: Repositório da Universidade de Lisboa
Assunto(s): Acute liver failure; Autoimmune hepatitis; Prognostic scores
Backround: In acute severe autoimmune hepatitis (AS-AIH), the early identification of predictors of non-response to corticosteroids and the optimal timing for liver transplantation (LT) remains controversial. Aims: To determine early predictors of non-response to corticosteroids and to assess the usefulness of severity scores, namely the recently developed SURFASA. Methods: Retrospective multicentre cohort study including consecutive patients admitted for AS-AIH between 2016 and 2020. Definitions- response to corticosteroids: LT-free survival at 90 days (D90); SURFASA score: -6.8 + 1.92x(D0-INR)+1.94xINR[(D3-D0)/D0]+1.64xbilirubin[(D3-D0)/D0]. Results: We included 26 patients [median age 56 (45-69) years; 22 (84.6%) women]. All patients underwent corticosteroid therapy. Overall survival reached 73%. amongst the non-responders, 2 (7.8%) underwent LT and 5 (19.2%) died. The interval between admission and initiation of corticosteroids was not different between responders and non- responders [13 (7-23) vs. 8 (3-10), P:0.06], respectively. SURFASA and MELD-Na+ (D3) scores showed an AUROC of 0.96 (0.87-1) and 0.92 (0.82-0.99), respectively, for prediction of non-response. SURFASA >-2.5 had a sensitivity of 85.7% and a specificity of 100% and MELD-Na+ (D3) >26 had sensitivity of 85.7% and a specificity of 78% for the prediction of non-response. Conclusions: SURFASA and MELD-Na+ at D3 scores are useful in early identification of non-responders to corticosteroids.
