Natural History of Patients Presenting with Autoimmune Hepatitis and Coincident Nonalcoholic Fatty Liver Disease.
Given the increase of nonalcoholic fatty liver disease (NAFLD) in the general population, a similar rise might be expected in autoimmune hepatitis (AIH) patients.



We sought to determine the clinical outcome of patients with coincident AIH and NAFLD.



We identified all intradepartmental AIH cases, and those meeting study criteria were placed into one of three cohorts: AIH only, AIH and simple steatosis (SS), and AIH and nonalcoholic steatohepatitis (NASH). The following outcome and clinical data were analyzed: incidence of all-cause mortality, incidence of liver-related mortality, incidence of liver-related adverse outcomes, and prevalence of cirrhosis at index biopsy.



Out of a total 73 study patients, 14 % classified as AIH with SS and 16 % as AIH and NASH. Fifty percent of AIH and NASH patients had cirrhosis at index biopsy as compared to 18 % of AIH-only patients (p = 0.032). Patients with AIH and NASH had a relative risk of 7.65 (95 % CI 1.43-40.8) for liver-related mortality and 2.55 (95 % CI 0.92-7.09) for liver-related adverse outcomes, as compared to the AIH-only cohort. No significant difference in outcome measures existed in comparing (AIH only) with (AIH and SS) cohorts.



Patients with coincident AIH and NASH were more likely to present with cirrhosis and more likely to develop adverse clinical outcome with decreased survival as compared to AIH-only patients. These findings suggest that simultaneous exposure confers a clinically significant increased risk, which may warrant closer follow-up and surveillance.
Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, 89 Beaumont Avenue, Courtyard at Given S269, Burlington, VT, 05405, USA. Javier.DeLuca-Johnson@uvmhealth.org.
Javier
J
De Luca-Johnson
Division of Gastroenterology, Department of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.|Department of Medicine, University of Vermont Medical Center, 111 Colchester Avenue, Fletcher 311, Burlington, VT, 05401, USA.
Kirk J
KJ
Wangensteen
Department of Pathology, University of New Mexico, Reginald Heber Fitz Hall, Room 335, 915 Camino de Salud, Albuquerque, NM, 87131, USA.
Joshua
J
Hanson
Department of Medicine, University of Vermont Medical Center, 111 Colchester Avenue, Fletcher 311, Burlington, VT, 05401, USA.
Edward
E
Krawitt
Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, 89 Beaumont Avenue, Courtyard at Given S269, Burlington, VT, 05405, USA.
Rebecca
R
Wilcox
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D016022:Case-Control Studies; D002423:Cause of Death; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D019693:Hepatitis, Autoimmune / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D014707:Vermont / Q000453:epidemiology; D055815:Young Adult
D005938:Glucocorticoids; D007166:Immunosuppressive Agents
Autoimmune hepatitis; Diabetes mellitus; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Obesity