Effects Of Corticosteroids In Autoimmune Hepatitis At Decompensated Stage

Aims:Corticosteroids is the drug of choice for autoimmune hepatitis(AIH).No studies yet to address the usefulness of corticosteroids therapy in AIH patients with decompensated cirrhosis.In this study we sought to determine the therapeutic effect of corticosteroids in this special group of AIH patients.Methods:Eighty-two AIH patients with decompensated cirrhosis were included consecutively through a retrospective analysis of all the AIH patients in database of our center from January 2009 to September 2015.Among them,64 patients were treated with corticosteroids while 18 patients were not.Clinical,laboratory,imaging,histological characteristics and outcomes of these patients were analyzed in order to investigate the efficacy and safety of corticosteroids therapy and screen predictive factors associated with outcomes.Results:Steroid-untreated patients were older than treated patients(68 years vs.58years,p=0.003)with a higher mortality(50%vs.14.1%,p=0.003).Of 64 patients treated with steroids,40 patients getting improvement to compensated stage with absence of complications were defined as“reversed patients”,while 15 patients sustained in decompensated stage and 9 patients with liver-related death or transplantation were defined as“non-reversed patients”.Compared to non-reversed patients,reversed patients demonstrated significantly higher ALT(92.0 vs.38.5 IU/L,p=0.036),AST(120.5 vs.54.0 IU/L,p=0.014),GGT(85.65 vs.56.4 IU/L,p=0.013),WBC(4.44 vs.2.78×10~9/L,p=0.002)and PLT(105 vs.58.5×10~9/L,p<0.001)levels at presentation,as well as significantly lower changes(?)in total bilirubin(TBIL)and MELD score at day 7 after treatment(?TBIL:-0.71 vs.0 mg/dl,p<0.001;?MELD:-2 vs.0,p=0.001).?TBIL and?MELD revealed the best predictive effects of treatment outcomes,which were assessed by the area under the receiver operator characteristic curve(AUROC)values(?TBIL,0.871;?MELD,0.795)and correlated with the survival.Infection was the most predominant cause of terminal events in treated group,followed by hepatic encephalopathy,refractory ascites and cholestasis.A low-dose corticosteroids administration in AIH patients with decompensated cirrhosis are relatively safe,and most patients can tolerate the steroids-related side effects without drug withdrawal.Conclusions:Corticosteroid therapy is useful and safe to treat AIH patients with decompensated cirrhosis,even two thirds of patients improved to compensated stage after therapy.Dynamic changes of TBIL and MELD score are favorable predictors of clinical outcomes after treatment,and should be monitored to modify the therapeutic strategies accordingly.Infection is the major cause of death or transplantation,which demands management intensively during the clinical course.