Keiichi Fujiwara1, Shin Yasui2, Yutaka Yonemitsu2, Makoto Arai2, Tatsuo Kanda2, Yoshihiro Fukuda3, Masayuki Nakano4, Shigeto Oda5, Osamu Yokosuka2. 1. Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. fujiwara-cib@umin.ac.jp. 2. Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. 3. Department of Gastroenterology, Seikeikai Chiba Medical Center, Chiba, Japan. 4. Division of Pathology, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan. 5. Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
Abstract
BACKGROUND: Autoimmune hepatitis (AIH) is one of major etiologies of acute liver failure (ALF), and the survival rate without liver transplantation (LT) of patients with fulminant AIH is especially poor worldwide. We investigated the clinicopathological features of infectious complications in autoimmune ALF retrospectively and tried to determine when to continue corticosteroid (CS) treatment or abandon it for LT. METHODS: Twenty patients with autoimmune ALF, comprising five severe hepatitis, 13 fulminant hepatitis and two late onset hepatic failure, were analyzed. RESULTS: Corticosteroids were administered to 19 patients. Seventeen infectious complications were observed in 12 patients. The median (range) duration between the introduction of CS and onset of infection was 15 (10–41) days. There were no significant differences in clinicobiochemical features between patients with and without infection. Of 20 patients, eight (40%) recovered without LT, four (20%) received LT and eight (40%) died without LT. Dead or transplanted patients had more advanced liver failure on admission than recovered ones (P < 0.01). CONCLUSIONS: Two-week after the introduction of CS is a critical point for avoiding infectious complications. Therefore, we should have evaluated efficacy of CS and performed LT by then at the latest in case of failure to improve.
BACKGROUND:Autoimmune hepatitis (AIH) is one of major etiologies of acute liver failure (ALF), and the survival rate without liver transplantation (LT) of patients with fulminant AIH is especially poor worldwide. We investigated the clinicopathological features of infectious complications in autoimmune ALF retrospectively and tried to determine when to continue corticosteroid (CS) treatment or abandon it for LT. METHODS: Twenty patients with autoimmune ALF, comprising five severe hepatitis, 13 fulminant hepatitis and two late onset hepatic failure, were analyzed. RESULTS: Corticosteroids were administered to 19 patients. Seventeen infectious complications were observed in 12 patients. The median (range) duration between the introduction of CS and onset of infection was 15 (10–41) days. There were no significant differences in clinicobiochemical features between patients with and without infection. Of 20 patients, eight (40%) recovered without LT, four (20%) received LT and eight (40%) died without LT. Dead or transplanted patients had more advanced liver failure on admission than recovered ones (P < 0.01). CONCLUSIONS: Two-week after the introduction of CS is a critical point for avoiding infectious complications. Therefore, we should have evaluated efficacy of CS and performed LT by then at the latest in case of failure to improve.
Authors: Luis Téllez; Eugenia Sánchez Rodríguez; Enrique Rodríguez de Santiago; Laura Llovet; Ana Gómez-Outomuro; Fernando Díaz-Fontenla; Patricia Álvarez López; María García-Eliz; Carla Amaral; Yolanda Sánchez-Torrijos; José Ignacio Fortea; Carlos Ferre-Aracil; Manuel Rodríguez-Perálvarez; Marta Abadía; Judith Gómez-Camarero; Antonio Olveira; José Luis Calleja; Javier Crespo; Manuel Romero; Manuel Hernández-Guerra; Marina Berenguer; Mar Riveiro-Barciela; Magdalena Salcedo; Manuel Rodríguez; María Carlota Londoño; Agustín Albillos Journal: Aliment Pharmacol Ther Date: 2022-04-25 Impact factor: 9.524