title: Persistent normalization of serum alanine aminotransferase levels improves the prognosis of type 1 autoimmune hepatitis.
abstract: 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.
authors.affiliation: 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
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyake
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Ryo
authors.initials: R
authors.lastname: Terada
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Takagi
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Okamaoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ikeda
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sakai
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Makino
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kobashi
authors.forename: Kouichi
authors.initials: K
authors.lastname: Takaguchi
authors.forename: Kohsaku
authors.initials: K
authors.lastname: Sakaguchi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shiratori
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D011239:Prednisolone; D000410:Alanine Transaminase