Background and Aims Acute severe autoimmune hepatitis (AS‐AIH) is an evolving concept and the outcomes and optimal treatment have been less studied. In this study, we aimed to investigate the outcomes of patients with AS‐AIH and predictors of non‐response to corticosteroid therapy and need for liver transplantation. Methods In a retrospective cohort, we included patients with AS‐AIH admitted to our liver center. We defined AS‐AIH based on the international autoimmune hepatitis group score as acute presentation of AIH with an international normalized ratio (INR) ≥ 1.5 and without liver cirrhosis and hepatic encephalopathy. All patients received high dose corticosteroid therapy. Treatment response was defined as liver transplant free survival at 4 months after presentation. Factors associated with response to corticosteroids and survival of patients were studied. Results In total, 61 patients with AS‐AIH were included. Forty‐seven patients responded to corticosteroid therapy. In the multivariate regression model, baseline INR (odds ratio [OR]: 0.184; 95% confidence interval [CI]: 0.048–0.699; p = 0.013) and delayed versus early initiation of corticosteroid (after vs. before 5 days of presentation) (OR: 0.189; 95% CI: 0.039–0.919; p = 0.039) were independent predictors of clinical non‐response to corticosteroid therapy. In the multivariable Cox regression model, baseline INR level (hazard ratio [HR]: 2.542; 95% CI: 1.188–5.440; p = 0.016) and delayed initiation of corticosteroids (HR: 3.578; 95% CI: 1.084–11.812; p = 0.036) were independent predictors of liver transplant free survival at 6 months after diagnosis. Conclusion Delayed initiation of corticosteroid therapy might be predictive of clinical non‐response to medical therapy and need for liver transplantation in patients with AS‐AIH.
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Eshraghian et al. (2024) studied this question.