Early predictors of short term prognosis in acute and acute severe autoimmune hepatitis.

Background and aims Presentation of autoimmune hepatitis (AIH) can differ from non-acute, to acute AIH (A-AIH) with jaundice and acute severe (AS-AIH) with jaundice and coagulopathy. The aim of the study was to evaluate the short term prognosis of different presentations of AIH and the influence of liver function improvement on short term prognosis. Methods In this single center retrospective cohort study AIH patients with repeatedly determined liver function at diagnosis and during at least 1 year of follow-up were included. A-AIH was defined as bilirubin >45 µmol and INR 45 µmol/L and INR ≥1.5 RESULTS: 17 (21%) patients presented with A-AIH and 14 (17%) presented with AS-AIH of the 81 included patients. After start of immunosuppressive therapy bilirubin, albumin and INR normalized in 70%, 77% and 69% in median 2.6 months, 3 months and 4 weeks respectively in patients with A-AIH and AS-AIH. Liver transplant free survival rate was 100% in non-acute AIH, 94% in A-AIH and 57% in AS-AIH at 12 months after diagnosis. Increase of INR or bilirubin at 2 weeks was the best predictive factor for need of liver transplantation within 12 months with a Youden's index of 0.85. Conclusion Acute AIH was present in 21% and AS-AIH in 17% of AIH patients. In the majority of patients bilirubin, albumin and INR normalized in the first months of treatment. Deterioration of liver function after two weeks of treatment should lead to rapid evaluation for liver transplantation and consideration of second-line medication.