Persistent normalization of serum alanine aminotransferase levels improves the prognosis of type 1 autoimmune hepatitis.
OBJECTIVE
Autoimmune hepatitis shows a good response to immunosuppressive treatment, and the prognosis may be determined by the clinical course. The present study was conducted in order to analyze the factors contributing to the outcomes of patients with type 1 autoimmune hepatitis.


METHODS
Eighty-four consecutive patients with type 1 autoimmune hepatitis were followed up regularly for a median follow-up period of 70.5 months (16.2-163 months). We analyzed the prognostic factors using time-fixed and time-dependent Cox proportional hazard models. The end point was progression of the disease to decompensated liver cirrhosis.


RESULTS
Seventy-seven patients (92%) were treated with prednisolone during the follow-up period, and 11 patients (13%) developed decompensated liver cirrhosis. Using a time-dependent multivariate model, the starting dose of corticosteroid (dose of prednisolone <20 mg/day), relapse within 3 months after the normalization of serum alanine aminotransferase levels with initial treatment, and elevated serum alanine aminotransferase levels during the follow-up period (>40 IU/L), all showed a significant association with progression of the disease.


CONCLUSIONS
The prognosis of type 1 autoimmune hepatitis on adequate immunosuppressive treatment improves when the serum alanine aminotransferase level persists at < or = 40 IU/L. Factors existing prior to medical treatment may not affect the prognosis.
Miyake
Yasuhiro
Y
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine and Dentistry, 2-5-1, Shikata-cho, Okayama 700-8558, Japan. miyakeyasuhiro@hotmail.com
Iwasaki
Yoshiaki
Y
Terada
Ryo
R
Takagi
Shinjiro
S
Okamaoto
Ryoichi
R
Ikeda
Hiroshi
H
Sakai
Nobuyuki
N
Makino
Yasuhiro
Y
Kobashi
Haruhiko
H
Takaguchi
Kouichi
K
Sakaguchi
Kohsaku
K
Shiratori
Yasushi
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D018450:Disease Progression; D005260:Female; D019693:Hepatitis, Autoimmune / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000209:etiology; D017093:Liver Failure / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D011239:Prednisolone; D000410:Alanine Transaminase