BACKGROUND & AIMS: Untreated patients with autoimmune hepatitis (AIH) who present with aspartate aminotransferase (AST) levels that are more than 5-fold greater than the upper limit of normal (UPLN) have a mortality rate of up to 80%. This study evaluated whether serum AST levels of patients, determined at presentation, are associated with disease course or outcome. METHODS: The records of 235 patients (median age, 46 y; range, 5-80 y) who presented with AIH, based on International AIH Group score (median, 22; range, 16-28), between 1970 and 2005, were examined. AST levels at presentation were available for 213 patients, who were assigned to 3 groups: group 1, AST less than 2x the UPLN, n = 26 (median, 62 IU; range, 23-97 IU); group 2, AST 2 to 10x the UPLN, n = 71 (median, 241 IU; range, 107-500 IU); and group 3, AST greater than 10x the UPLN, n = 116 (median, 1073 IU; range, 563-4603 IU). RESULTS: Patients in groups 1 and 2 had a significantly worse outcome (risk of liver transplantation or death) compared with those in group 3 (60% survival vs 82%; P = .01; odds ratio, 2.1). These patients were more likely to present with ascites (P < .001), hematemesis (P = .009), and cirrhosis or advanced fibrosis based on an index biopsy (P < .001). Patients in groups 1 and 2 also had lower bilirubin levels at presentation (P < .001) and were less likely to be symptomatic (P < .001). CONCLUSIONS: In patients with AIH, AST levels greater than 10x the UPLN at presentation were associated with a lower risk of cirrhosis and a better long-term outcome than those with AST levels that were less than 10x the UPLN.
BACKGROUND & AIMS: Untreated patients with autoimmune hepatitis (AIH) who present with aspartate aminotransferase (AST) levels that are more than 5-fold greater than the upper limit of normal (UPLN) have a mortality rate of up to 80%. This study evaluated whether serum AST levels of patients, determined at presentation, are associated with disease course or outcome. METHODS: The records of 235 patients (median age, 46 y; range, 5-80 y) who presented with AIH, based on International AIH Group score (median, 22; range, 16-28), between 1970 and 2005, were examined. AST levels at presentation were available for 213 patients, who were assigned to 3 groups: group 1, AST less than 2x the UPLN, n = 26 (median, 62 IU; range, 23-97 IU); group 2, AST 2 to 10x the UPLN, n = 71 (median, 241 IU; range, 107-500 IU); and group 3, AST greater than 10x the UPLN, n = 116 (median, 1073 IU; range, 563-4603 IU). RESULTS:Patients in groups 1 and 2 had a significantly worse outcome (risk of liver transplantation or death) compared with those in group 3 (60% survival vs 82%; P = .01; odds ratio, 2.1). These patients were more likely to present with ascites (P < .001), hematemesis (P = .009), and cirrhosis or advanced fibrosis based on an index biopsy (P < .001). Patients in groups 1 and 2 also had lower bilirubin levels at presentation (P < .001) and were less likely to be symptomatic (P < .001). CONCLUSIONS: In patients with AIH, AST levels greater than 10x the UPLN at presentation were associated with a lower risk of cirrhosis and a better long-term outcome than those with AST levels that were less than 10x the UPLN.
Authors: Harpreet K Dhaliwal; Barbara S Hoeroldt; Asha K Dube; Elaine McFarlane; James C E Underwood; Mohammed A Karajeh; Dermot Gleeson Journal: Am J Gastroenterol Date: 2015-05-26 Impact factor: 10.864
Authors: Richard Taubert; Matthias Hardtke-Wolenski; Fatih Noyan; Claudine Lalanne; Danny Jonigk; Jerome Schlue; Till Krech; Ralf Lichtinghagen; Christine S Falk; Verena Schlaphoff; Heike Bantel; Luigi Muratori; Michael P Manns; Elmar Jaeckel Journal: PLoS One Date: 2017-06-08 Impact factor: 3.240
Authors: Maurice Michel; Francesca Spinelli; Annette Grambihler; Christian Labenz; Michael Nagel; Leonard Kaps; Yvonne Huber; Peter R Galle; Marcus-Alexander Wörns; Jörn M Schattenberg Journal: Qual Life Res Date: 2021-05-12 Impact factor: 4.147
Authors: Maaike Biewenga; Xavier P D M J Verhelst; Martine A M C Baven-Pronk; Hein Putter; Aad P van den Berg; Karin C M J van Nieuwkerk; Henk R van Buuren; Gerd Bouma; Ynte S de Boer; Cedric Simoen; Isabelle Colle; Jeoffrey Schouten; Filip Sermon; Christophe van Steenkiste; Hans van Vlierberghe; Adriaan J van der Meer; Frederik Nevens; Bart van Hoek Journal: United European Gastroenterol J Date: 2021-06-24 Impact factor: 4.623