Frequency and predictive factors for overlap syndrome between autoimmune hepatitis and primary cholestatic liver disease.
OBJECTIVE
To evaluate the frequency of cholestatic pattern in patients with autoimmune hepatitis (AIH) and to identify predictive factors associated with the development of the overlap syndrome.


METHODS
Eighty-two consecutive patients diagnosed with AIH at the referral centre between January 1998 and June 2002 were included in the study. The new scoring system modified by the International Autoimmune Hepatitis Group was used to classify patients as definite/probable. Overlap syndrome was considered when the patient had clinical, serological and histological characteristics of two conditions: AIH and primary biliary cirrhosis (PBC) or AIH and primary sclerosing cholangitis (PSC).


RESULTS
From the 82 AIH patients (76 female and six male), 84.1% presented definite AIH (> 15 points) and 15.9% probable AIH (10 - 15 points). The frequency of the overlap syndrome was 20%: 13% with PBC and 7% with PSC. In the univariate analysis the overlap syndrome was associated with male gender (P = 0.01), age < 35 years (P < 0.0001), histopathological aspect of cholestasis (P < 0.0001), suboptimal response to treatment (P < 0.0001) and probable AIH (P < 0.0001). Age < 35 years, probable AIH and the absence of anti-nuclear antibody (ANA) have been identified as independent indicators of the overlap diagnosis by the logistic regression analysis.


CONCLUSIONS
Patients with overlap syndrome between AIH and primary cholestatic liver disease are frequently diagnosed in clinical practice, representing 20% of AIH cases in our study. The independent predictive factors associated with the diagnosis of overlap syndrome are young age, ANA(-) profile, and probable diagnosis according with the scoring system for AIH.
Gheorghe
Liana
L
Centre of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. drgheorghe@xnet.ro
Iacob
Speranta
S
Gheorghe
Cristian
C
Iacob
Razvan
R
Simionov
Iulia
I
Vadan
Roxana
R
Becheanu
Gabriel
G
Parvulescu
Iuliana
I
Toader
Cristina
C
D000328:Adult; D000367:Age Factors; D000974:Antibodies, Antinuclear / Q000032:analysis; D015209:Cholangitis, Sclerosing / Q000209:etiology*; D004812:Epidemiologic Methods; D005260:Female; D019693:Hepatitis, Autoimmune / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013577:Syndrome
D000974:Antibodies, Antinuclear