Fatores relacionados à resposta ao tratamento na hepatite autoimune

Abstract

Background: Autoimmune hepatitis (AIH) is a rare disease with a complex and not fully understood pathogenesis. Prognostic factors that might influence treatment response, relapse rates, transplantation needs and death are not well established. The major aim of the study is to investigate possible markers associated with response to immunosuppression. Other goals are to evaluate the epidemiologic profile of patients with AIH, considering the severity of presentation, mortality rates, transplant needs, relapse and the predictors modifying these outcomes. Methods: This is an observational study with a retrospective evaluation of a longitudinal cohort. 102 patients were selected at the Hepatology Ambulatory of Federal University of Minas Gerais’ Hospital from 1990-2018, from both sexes, that fulfilled criteria of possible or definite diagnosis of AIH and that were given immunosuppressant. Overlap syndromes were excluded. Pretreatment data as such as clinical profile, laboratory and histological exams were analyzed with regard to biochemical response in one year, histological remission, transplantation, relapse and death. Statistical analysis were done by Mann-Whitney´s U test, Student´s T test, chi-square and further by logistic regression. Kaplan Meier´s survival graphic was performed to evaluate overall survival and transplant-free survival, applying Cox regression when necessary. The fixed p level was 5%. Results: The biochemical and histological remission rates were similar to other Brazilian studies, although different from international literature. Cirrhosis was present in 59% at diagnosis and reduced biochemical response rate in one year in 73,7%. Increments in age was associated with a higher rate of cirrhosis at presentation. There were no significant predictors of histological remission. 6% underwent liver transplant in a median of time of 9.4 years from the diagnosis. Biochemical response was an important protective factor regarding transplantation, reducing the risk in 86%. Overall survival was 89% and 4 patients died in 340 months. Ascites at presentation, associated with higher AST/ALT relation and MELD, increased the risk of death in 20 times. Conclusion: AIH prognosis is directly influenced by distinguished characteristics of each population studied. Multi-centric studies would be necessary to identify non-invasive markers or clinical scores in order to predict the probability of different outcomes with a relevant impact on the accurate disease management.