title: Clinical characteristics and corticosteroid therapy in patients with autoimmune-hepatitis-induced liver failure.
abstract: OBJECTIVE
  To investigate the clinical features, response to corticosteroids, and prognosis of autoimmune hepatitis (AIH)-induced liver failure in China.
  
  
  METHODS
  A total of 22 patients (19 female and 3 male; average age 51 ± 15 years) with AIH-induced liver failure treated in our hospital from 2004 to 2012 were retrospectively analyzed. Clinical, biochemical and pathological characteristics of the 22 patients and responses to corticosteroid treatment in seven patients were examined retrospectively. The patients were divided into survivor and non-survivor groups, and the clinical characteristics and prognosis were compared between the two groups. The t test was used for data analysis of all categorical variables, and overall survival was calculated by the Kaplan-Meier method.
  
  
  RESULTS
  At the time of diagnosis, mean IgG was 2473 ± 983 mg/dL, with three (18.8%) patients showing normal levels. All of the patients had elevated serum levels of antinuclear antibody (≥ 1:640). Liver histology from one patient showed diagnostic pathological changes, including massive necrosis and plasma cell infiltration. Four patients survived (18.2%) and 18 died (81.8%) without liver transplantation. The results showed that patients with low admission Model for End-Stage Liver Disease (MELD) scores (21.50 ± 2.08 vs 30.61 ± 6.70, P < 0.05) and corticosteroid therapy (100% vs 16.7%, P < 0.05) had better prognosis. A total of seven patients received corticosteroid therapy, of whom, four responded and survived, and the other three died. Survivors showed young age, shorter duration from diagnosis to corticosteroid therapy, low MELD score, and absence of hepatic encephalopathy at the time of corticosteroid administration. Six patients who were administered corticosteroids acquired fungal infections but recovered after antifungal therapy.
  
  
  CONCLUSIONS
  Early diagnosis and corticosteroid therapy are essential for improving the prognosis of patients with AIH-induced liver failure without liver transplantation.
authors: Bing Zhu, Shao-Li You, Zhi-Hong Wan, Hong-Ling Liu, Yi-Hui Rong, Hong Zang, Shao-Jie Xin, Liver Failure Treatment and Research Center, 302 Military Hospital, Beijing 100039, China.
authors: Bing
authors: B
authors: Zhu
authors: Bing Zhu, Shao-Li You, Zhi-Hong Wan, Hong-Ling Liu, Yi-Hui Rong, Hong Zang, Shao-Jie Xin, Liver Failure Treatment and Research Center, 302 Military Hospital, Beijing 100039, China.
authors: Shao-Li
authors: SL
authors: You
authors: Bing Zhu, Shao-Li You, Zhi-Hong Wan, Hong-Ling Liu, Yi-Hui Rong, Hong Zang, Shao-Jie Xin, Liver Failure Treatment and Research Center, 302 Military Hospital, Beijing 100039, China.
authors: Zhi-Hong
authors: ZH
authors: Wan
authors: Bing Zhu, Shao-Li You, Zhi-Hong Wan, Hong-Ling Liu, Yi-Hui Rong, Hong Zang, Shao-Jie Xin, Liver Failure Treatment and Research Center, 302 Military Hospital, Beijing 100039, China.
authors: Hong-Ling
authors: HL
authors: Liu
authors: Bing Zhu, Shao-Li You, Zhi-Hong Wan, Hong-Ling Liu, Yi-Hui Rong, Hong Zang, Shao-Jie Xin, Liver Failure Treatment and Research Center, 302 Military Hospital, Beijing 100039, China.
authors: Yi-Hui
authors: YH
authors: Rong
authors: Bing Zhu, Shao-Li You, Zhi-Hong Wan, Hong-Ling Liu, Yi-Hui Rong, Hong Zang, Shao-Jie Xin, Liver Failure Treatment and Research Center, 302 Military Hospital, Beijing 100039, China.
authors: Hong
authors: H
authors: Zang
authors: Bing Zhu, Shao-Li You, Zhi-Hong Wan, Hong-Ling Liu, Yi-Hui Rong, Hong Zang, Shao-Jie Xin, Liver Failure Treatment and Research Center, 302 Military Hospital, Beijing 100039, China.
authors: Shao-Jie
authors: SJ
authors: Xin
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002681:China; D042241:Early Diagnosis; D005260:Female; D019693:Hepatitis, Autoimmune / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers
keywords: Autoantibody; Autoimmune hepatitis; Corticosteroid therapy; Liver failure; Prognosis