Victoria Gordon1, Ratul Adhikary2, Victoria Appleby3, Debasis Das4, James Day5, Toby Delahooke6, Selena Dixon7, David Elphick8, Claire Hardie9, Barbara Hoeroldt10, Patricia Hooper11, John Hutchinson12, Rebecca Jones13, Faisal Khan14, Guruprasad P Aithal15, John McGonigle16, Andrew Nelson17, Alick Nkhoma18, Stavroula Pelitari19, Martin Prince20, Annell Prosser21, Vinay Sathanarayana22, Sophia Savva23, Naina Shah24, Sushma Saksena25, Sreedhari Thayalasekaran26, Deven Vani27, Andrew Yeoman28, Dermot Gleeson1. 1. Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK. 2. Calderdale Royal Hospital, Halifax, UK. 3. Bradford teaching Hospitals Foundation Trust, Bradford, UK. 4. Stepping Hill Hospital, Stockport, UK. 5. Addenbrooks, Cambridge, UK. 6. University Hospitals Leicester, Leicester, UK. 7. Airedale NHS Foundation Trust, Airedale, UK. 8. Chesterfield Royal Hospital, Chesterfield, UK. 9. Freeman Hospital, Newcastle upon Tyne, UK. 10. Rotherham Foundation NHS Trust, Rotherham, UK. 11. Royal Derby Hospital, Derby, UK. 12. York Teaching Hospital NHS Foundation Trust, York, UK. 13. St James's University Hospital, Leeds, UK. 14. Doncaster Royal Infirmary, Doncaster, UK. 15. Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK. 16. North Tees University Hospital, Hartlepool, UK. 17. Scarborough Hospital, Scarborough, UK. 18. Darlington Memorial Hospital, Darlington, UK. 19. University Hospitals Coventry Warwickshire, Coventry, UK. 20. Manchester Royal Infirmary, Manchester, UK. 21. Singleton Hospital, Swansea, UK. 22. Barnsley District General Hospital, Barnsley, UK. 23. Kettering General Hospital, Kettering, UK. 24. Kings College Hospital, London, UK. 25. University Hospital North Durham, Durham, UK. 26. Hull Royal Infirmary, Hull, UK. 27. Mid-Yorkshire Hospital, Yorkshire, UK. 28. Royal Gwent Hospital, Newport, UK.
Abstract
BACKGROUND & AIMS: There is limited information regarding patients with AIH outside relatively few large centres. We describe here the presenting features of patients with AIH, collected as part of an audit involving 28 UK hospitals. METHODS: Patients (incident since 1/1/2007 or prevalent since 1/1/2000) were ≥18 years and either met 1999 International AIH Group (IAIHG) diagnostic criteria (n = 1164), or received immunosuppressive therapy for clinically diagnosed AIH (n = 103). RESULTS: Of 1267 patients (80% women, 91% Caucasian, age (median(range)) 55(8-86) years, 0.5% had acute viral hepatitis (CMV/EBV/HEV); 2% were taking Nitrofurantoin and 0.7% Khat. Twenty-one percent had clinical decompensation and/or a MELD score of >15. Time from first abnormal liver tests to diagnosis was ≥1 year in 19% and was longer in jaundiced vs non-jaundiced patients. HBV and HCV serology were undocumented in 4%, serum immunoglobulins in 31% and autoantibodies in 11%-27%. When documented, ≥1 antibody was present in 83%. LKM-1-positive and autoantibody-negative patients had more severe disease. Histological cirrhosis was reported in 23%, interface hepatitis 88%, predominant lymphocytes/plasma cells 75%, rosettes 19% and emperipolesis 0.4%. Only 65% of those meeting 1999 IAIHG criteria also met simplified IAIHG criteria. University Hospitals compared to District General Hospitals, were more likely to report histological features of AIH. CONCLUSIONS: This cohort from across the UK is older than other multicentre AIH cohorts. One-fifth had decompensation or MELD >15. Diagnosis was delayed in 19%, diagnostic testing was incomplete in one-third and rosettes and emperipolesis were infrequently reported.
BACKGROUND & AIMS: There is limited information regarding patients with AIH outside relatively few large centres. We describe here the presenting features of patients with AIH, collected as part of an audit involving 28 UK hospitals. METHODS: Patients (incident since 1/1/2007 or prevalent since 1/1/2000) were ≥18 years and either met 1999 International AIH Group (IAIHG) diagnostic criteria (n = 1164), or received immunosuppressive therapy for clinically diagnosed AIH (n = 103). RESULTS: Of 1267 patients (80% women, 91% Caucasian, age (median(range)) 55(8-86) years, 0.5% had acute viral hepatitis (CMV/EBV/HEV); 2% were taking Nitrofurantoin and 0.7% Khat. Twenty-one percent had clinical decompensation and/or a MELD score of >15. Time from first abnormal liver tests to diagnosis was ≥1 year in 19% and was longer in jaundiced vs non-jaundiced patients. HBV and HCV serology were undocumented in 4%, serum immunoglobulins in 31% and autoantibodies in 11%-27%. When documented, ≥1 antibody was present in 83%. LKM-1-positive and autoantibody-negative patients had more severe disease. Histological cirrhosis was reported in 23%, interface hepatitis 88%, predominant lymphocytes/plasma cells 75%, rosettes 19% and emperipolesis 0.4%. Only 65% of those meeting 1999 IAIHG criteria also met simplified IAIHG criteria. University Hospitals compared to District General Hospitals, were more likely to report histological features of AIH. CONCLUSIONS: This cohort from across the UK is older than other multicentre AIH cohorts. One-fifth had decompensation or MELD >15. Diagnosis was delayed in 19%, diagnostic testing was incomplete in one-third and rosettes and emperipolesis were infrequently reported.
Authors: Victoria Mary Gordon; Ratul Adhikary; Guruprasad P Aithal; Victoria Appleby; Debasish Das; James Day; Toby Delahooke; Selena Dixon; David Elphick; Claire Hardie; Michael Heneghan; Barbara Hoeroldt; Patricia Hooper; John Hutchinson; Rebecca L Jones; Faisal Khan; Jane Metcalf; Alick Nkhoma; Stavroula Pelitari; Martin Prince; Annell Prosser; Sushma Saksena; Vinay Sathyanarayana; Deven Vani; Andrew Yeoman; Dermot Gleeson Journal: Frontline Gastroenterol Date: 2021-05-18
Authors: Katherine Arndtz; Elizabeth Shumbayawonda; James Hodson; Peter J Eddowes; Andrea Dennis; Helena Thomaides-Brears; Sofia Mouchti; Matt D Kelly; Rajarshi Banerjee; Stefan Neubauer; Gideon M Hirschfield Journal: Hepatol Commun Date: 2021-02-23