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Identifying the early predictors of non-response to steroids in patients with flare of autoimmune hepatitis causing acute-on-chronic liver failure

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收录情况： ◇ SCIE

作者：
Sanchit Sharma[1] * ; Samagra Agarwal[1] ; Anoop Saraya[1] ; Ashok Kumar Choudhury[2] ; Sanjiv Saigal[3] ; A. S. Soin[3] ; Akash Shukla[4] ; Manoj K. Sahu[5] ; Laurentius A. Lesmana[6] ; Renaldi C. Lesmana[6] ; Samir N. Shah[7] ; Jinhua Hu[8] ; Soek Siam Tan[9] ; Dinesh Jothimani[10] ; Mohammed Rela[10] ; Hasmik L. Ghazinyan[11] ; D. N. Amrapurkar[12] ; C. E. Eapen[13] ; Ashish Goel[13] ; Diana Alcantra Payawal[14] ; Saeed Hamid[15] ; Amna S. Butt[15] ; Duan Zhongping[16] ; Virender Singh[17] ; Ajay Duseja[17] ; Ajit Sood[18] ; Vandana Midha[18] ; Mamun Al Mahtab[19] ; Dong Joon Kim[20] ; Qin Ning[21] ; Anand V. Kulkarni[22] ; P. N. Rao[22] ; Guan Huei Lee[23] ; Sombat Treeprasertsuk[24] ; Xin Shaojie[25] ; Md. Fazal Karim[26] ; Jose D. Sollano[27] ; Kemal Fariz Kalista[28] ; Rino Alvani Gani[28] ; V. G. Mohan Prasad[29] ; Shiv Kumar Sarin[2] ;
单位： [1]Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110026, India [2]Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India [3]Department of Hepatology, Medanta, Medicity, Gurugram, Haryana, India [4]Department of Gastroenterology, LTMMC, Mumbai, Maharashtra, India [5]Department of Hepatology, IMS and SUM Hospital, Bhubneshwar, Odhisha, India [6]Department of Medicine, Medistra Hospital, Jakarta, Indonesia [7]Department of Hepatology, Global Hospital, Mumbai, India [8]Department of Medicine, 302 Military Hospital, Bejing, China [9]Department of Medicine, Hospital Selayang, Bata Cabs, Selangor, Malaysia [10]Department of Liver Transplant and Surgery, Dr. Rela Institute and Medical Centre, Chennai, India [11]Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia [12]Bombay Hospital, Mumbai, Maharashtra, India [13]Department of Hepatology, Christan Medical College, Vellore, India [14]Department of Medicine, Cardinal Santos Medical Center, Metro Manila, Philippines [15]Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan [16]Translational Hepatology Institute Capital Medical University, Beijing You’ an Hospital, Beijing, China [17]Department of Hepatology, PGIMER, Chandigarh, India [18]Department of Gastroenterology, Dayanand Medical College, Ludhiana, India [19]Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh [20]Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea [21]Department of Medicine,Tongji Hospital,Tongji Medical College,Wuhan,China [22]Asian Institute of Gastroenterology, Hyderabad, India [23]Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore [24]Department of Medicine, Chulalongkorn University, Bangkok, Thailand [25]Medical School of Chinese PLA, Beijing, China [26]Department of Hepatology, Sir Salimullah Medical College, Dhaka, Bangladesh [27]Department of Medicine, University of Santo Tomas, Manila, Philippines [28]Division of Hepatobiliary, Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia [29]Department of Gastroenterology, VGM Hospital, Coimbatore, India
出处：
DOI： 10.1007/s12072-023-10482-4
ISSN：

关键词： Autoimmune hepatitis Acute-on-chronic liver failure MELD score AARC score SURFASA score

摘要：
Early identification of non-response to steroids is critical in patients with autoimmune hepatitis (AIH) causing acute-on-chronic liver failure (ACLF). We assessed if this non-response can be accurately identified within first few days of treatment.Patients with AIH-ACLF without baseline infection/hepatic encephalopathy were identified from APASL ACLF research consortium (AARC) database. Diagnosis of AIH-ACLF was based mainly on histology. Those treated with steroids were assessed for non-response (defined as death or liver transplant at 90 days for present study). Laboratory parameters, AARC, and model for end-stage liver disease (MELD) scores were assessed at baseline and day 3 to identify early non-response. Utility of dynamic SURFASA score [- 6.80 + 1.92*(D0-INR) + 1.94*(∆%3-INR) + 1.64*(∆%3-bilirubin)] was also evaluated. The performance of early predictors was compared with changes in MELD score at 2 weeks.Fifty-five out of one hundred and sixty-five patients (age-38.2 ± 15.0 years, 67.2% females) with AIH-ACLF [median MELD 24 (IQR: 22-27); median AARC score 7 (6-9)] given oral prednisolone 40 (20-40) mg per day were analyzed. The 90 day transplant-free survival in this cohort was 45.7% with worse outcomes in those with incident infections (56% vs 28.0%, p = 0.03). The AUROC of pre-therapy AARC score [0.842 (95% CI 0.754-0.93)], MELD [0.837 (95% CI 0.733-0.94)] score and SURFASA score [0.795 (95% CI 0.678-0.911)] were as accurate as ∆MELD at 2 weeks [0.770 (95% CI 0.687-0.845), p = 0.526] and better than ∆MELD at 3 days [0.541 (95% CI 0.395, 0.687), p < 0.001] to predict non-response. Combination of AARC score > 6, MELD score > 24 with SURFASA score ≥ - 1.2, could identify non-responders at day 3 (concomitant- 75% vs either - 42%, p < 0.001).Baseline AARC score, MELD score, and the dynamic SURFASA score on day 3 can accurately identify early non-response to steroids in AIH-ACLF.© 2023. Asian Pacific Association for the Study of the Liver.

语种：
外文
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PubmedID：
中科院(CAS)分区：
出版当年[2022]版：
大类 | 2 区 医学
小类 | 2 区 胃肠肝病学
最新[2025]版：
大类 | 1 区 医学
小类 | 2 区 胃肠肝病学
JCR分区：
出版当年[2021]版：
Q1 GASTROENTEROLOGY & HEPATOLOGY
最新[2024]版：
Q1 GASTROENTEROLOGY & HEPATOLOGY

影响因子： 最新[2024版] 最新五年平均 出版当年[2021版] 出版当年五年平均 出版前一年[2020版] 出版后一年[2022版]

第一作者：
第一作者单位： [1]Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110026, India
通讯作者：
推荐引用方式(GB/T 7714)：
Sanchit Sharma,Samagra Agarwal,Anoop Saraya,et al.Identifying the early predictors of non-response to steroids in patients with flare of autoimmune hepatitis causing acute-on-chronic liver failure[J].HEPATOLOGY INTERNATIONAL.2023,17(4):989-999.doi:10.1007/s12072-023-10482-4.
APA：
Sanchit Sharma,Samagra Agarwal,Anoop Saraya,Ashok Kumar Choudhury,Sanjiv Saigal...&Shiv Kumar Sarin.(2023).Identifying the early predictors of non-response to steroids in patients with flare of autoimmune hepatitis causing acute-on-chronic liver failure.HEPATOLOGY INTERNATIONAL,17,(4)
MLA：
Sanchit Sharma,et al."Identifying the early predictors of non-response to steroids in patients with flare of autoimmune hepatitis causing acute-on-chronic liver failure".HEPATOLOGY INTERNATIONAL 17..4(2023):989-999

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