Liver and Bile
Dig Liver Dis. 2022;54(12):1681–5
Severe acute autoimmune hepatitis: How to early predict who will not respond to corticosteroids and needs urgent liver transplantation?
Background: In acute severe autoimmune hepatitis (AS-AIH), the early identification of predictors of non-response to corticosteroids and the optimal timing for liver transplantation remains controversial.
Aims: To determine early predictors of non-response to corticosteroids and to assess the usefulness of severity scores, namely the recently developed SURFASA.
Methods: Retrospective multicenter cohort study including consecutive patients admitted for AS-AIH between 2016 and 2020. Definitions-response to corticosteroids: LT-free survival at 90 days (D90); SURFASA score: -6.8+1.92x(D0-INR)+1.94xINR[(D3-D0)/D0]+1.64xbilirubin[(D3-D0)/D0].
Results: The authors included 26 patients (median age, 56 [45–69] years; 22 [84.6%] women). All patients underwent corticosteroid therapy. Overall survival reached 73%. Amongst the non-responders, 2 (7.8%) underwent liver transplantation and 5 (19.2%) died. The interval between admission and initiation of corticosteroids was not different between responders and non-responders (13 [7–23] vs. 8 [3–10], p = 0.06), respectively. SURFASA and MELD-Na+ (D3) scores showed an AUROC of 0.96 (0.87–1) and 0.92 (0.82–0.99), respectively, for prediction of non-response. SURFASA > -2.5 had a sensitivity of 85.7% and a specificity of 100% and MELD-Na+ (D3) > 26 had sensitivity of 85.7% and a specificity of 78% for the prediction of non-response.
Conclusions: SURFASA and MELD-Na+ at D3 scores are useful in early identification of non-responders to corticosteroids.