Prognosis of autoimmune hepatitis showing acute presentation

Kazuhide Yamamoto; Yasuhiro Miyake; Hiromasa Ohira; Yoshiyuki Suzuki; Mikio Zeniya; Morikazu Onji; Hirohito Tsubouchi; Kaname Yoshizawa; Toshio Morizane; Toshifumi Hibi; Yutaka Aoyagi; Yasuni Nakanuma; Junko Hirohara; Hajime Takikawa; Hiromi Ishibashi; Shinji Shimoda; Shotaro Sakisaka; Makoto Nakamuta; Yasushi Matsuzaki; Toshiji Saibara; Yoshiyuki Ueno; Hiroshi Miyakawa; Norihiro Kokudo; Hiroto Egawa; Yoshihiko Maehara; Satoshi Mochida; Isao Sakaida; Tomoo Fujisawa; Kazuyuki Suzuki; Kazuaki Inoue; Takafumi Ichida; Osamu Yokosuka; Hiroshi Fukui; Hisataka Moriwaki; Mitsuru Mori; Toshiyuki Mori; Masato Nagino; Naohiro Sata; Susumu Tazuma; Takahiro Yasaka; Toshio Tsuyuguchi; Junichi Shoda; Masao Honda; Hiroki Yamaue; Michiaki Unno; Norio Hayashi

doi:10.1111/j.1872-034X.2012.01109.x

Prognosis of autoimmune hepatitis showing acute presentation

Kazuhide Yamamoto, Yasuhiro Miyake, Hiromasa Ohira, Yoshiyuki Suzuki, Mikio Zeniya, Morikazu Onji, Hirohito Tsubouchi, Kaname Yoshizawa, Toshio Morizane, Toshifumi Hibi, Yutaka Aoyagi, Yasuni Nakanuma, Junko Hirohara, Hajime Takikawa, Hiromi Ishibashi, Shinji Shimoda, Shotaro Sakisaka, Makoto Nakamuta, Yasushi Matsuzaki, Toshiji SaibaraYoshiyuki Ueno, Hiroshi Miyakawa, Norihiro Kokudo, Hiroto Egawa, Yoshihiko Maehara, Satoshi Mochida, Isao Sakaida, Tomoo Fujisawa, Kazuyuki Suzuki, Kazuaki Inoue, Takafumi Ichida, Osamu Yokosuka, Hiroshi Fukui, Hisataka Moriwaki, Mitsuru Mori, Toshiyuki Mori, Masato Nagino, Naohiro Sata, Susumu Tazuma, Takahiro Yasaka, Toshio Tsuyuguchi, Junichi Shoda, Masao Honda, Hiroki Yamaue, Michiaki Unno, Norio Hayashi

MED - Medical Sciences

Research output: Contribution to journal › Article › peer-review

38 Citations (Scopus)

Abstract

Aim: The number of patients with autoimmune hepatitis (AIH) showing acute presentation has increased. This study aimed to assess their prognosis. Methods: A survey of AIH patients by sending questionnaires was performed, and 96 patients showing acute presentation were investigated. Results: The median age was 58 years and 78 patients (81%) were female. Eighty-four patients (88%) were positive for antinuclear antibody and/or anti-smooth muscle antibody. The median serum immunoglobulin G level was 2252mg/dL. Twenty-five patients (26%) showed histological acute hepatitis. As initial treatment, 88 patients (92%) were treated with corticosteroid, and 28 of them received pulse steroid treatment. Overall, 11 patients (11%) reached fatal outcomes (nine death and two liver transplantation). Patients with histological acute hepatitis showed higher serum bilirubin levels, lower prothrombin activities and higher prothrombin time-international normalized ratios (PT-INR) and reached fatal outcomes more frequently. With a multivariate logistic regression analysis, prothrombin activity and PT-INR at presentation was associated with fatal outcomes. Nine of 13 patients (69%) showing prothrombin activity of 40% or lower at presentation and nine of 19 patients (47%) showing PT-INR of 1.5 or higher reached fatal outcomes. Furthermore, of 13 patients showing prothrombin activity of 40% or lower and/or PT-INR of 1.5 or higher at presentation who were treated with pulse steroid treatment, four (31%) died from infectious disease. Conclusion: Prothrombin activity and PT-INR are prognostic factors for AIH showing acute presentation. Physicians should pay attention to the development of infectious disease when pulse steroid treatment is performed.

Original language	English
Pages (from-to)	630-638
Number of pages	9
Journal	Hepatology Research
Volume	43
Issue number	6
DOIs	https://doi.org/10.1111/j.1872-034X.2012.01109.x
Publication status	Published - 2013 Jun

Keywords

Acute presentation
Autoimmune hepatitis
Prothrombin activity
Prothrombin time-international normalized ratio
Pulse steroid treatment

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/j.1872-034X.2012.01109.x

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Yamamoto, K., Miyake, Y., Ohira, H., Suzuki, Y., Zeniya, M., Onji, M., Tsubouchi, H., Yoshizawa, K., Morizane, T., Hibi, T., Aoyagi, Y., Nakanuma, Y., Hirohara, J., Takikawa, H., Ishibashi, H., Shimoda, S., Sakisaka, S., Nakamuta, M., Matsuzaki, Y., ... Hayashi, N. (2013). Prognosis of autoimmune hepatitis showing acute presentation. Hepatology Research, 43(6), 630-638. https://doi.org/10.1111/j.1872-034X.2012.01109.x

@article{c74a4f7e594f49deb7c8912f790ec510,

title = "Prognosis of autoimmune hepatitis showing acute presentation",

abstract = "Aim: The number of patients with autoimmune hepatitis (AIH) showing acute presentation has increased. This study aimed to assess their prognosis. Methods: A survey of AIH patients by sending questionnaires was performed, and 96 patients showing acute presentation were investigated. Results: The median age was 58 years and 78 patients (81%) were female. Eighty-four patients (88%) were positive for antinuclear antibody and/or anti-smooth muscle antibody. The median serum immunoglobulin G level was 2252mg/dL. Twenty-five patients (26%) showed histological acute hepatitis. As initial treatment, 88 patients (92%) were treated with corticosteroid, and 28 of them received pulse steroid treatment. Overall, 11 patients (11%) reached fatal outcomes (nine death and two liver transplantation). Patients with histological acute hepatitis showed higher serum bilirubin levels, lower prothrombin activities and higher prothrombin time-international normalized ratios (PT-INR) and reached fatal outcomes more frequently. With a multivariate logistic regression analysis, prothrombin activity and PT-INR at presentation was associated with fatal outcomes. Nine of 13 patients (69%) showing prothrombin activity of 40% or lower at presentation and nine of 19 patients (47%) showing PT-INR of 1.5 or higher reached fatal outcomes. Furthermore, of 13 patients showing prothrombin activity of 40% or lower and/or PT-INR of 1.5 or higher at presentation who were treated with pulse steroid treatment, four (31%) died from infectious disease. Conclusion: Prothrombin activity and PT-INR are prognostic factors for AIH showing acute presentation. Physicians should pay attention to the development of infectious disease when pulse steroid treatment is performed.",

keywords = "Acute presentation, Autoimmune hepatitis, Prothrombin activity, Prothrombin time-international normalized ratio, Pulse steroid treatment",

author = "Kazuhide Yamamoto and Yasuhiro Miyake and Hiromasa Ohira and Yoshiyuki Suzuki and Mikio Zeniya and Morikazu Onji and Hirohito Tsubouchi and Kaname Yoshizawa and Toshio Morizane and Toshifumi Hibi and Yutaka Aoyagi and Yasuni Nakanuma and Junko Hirohara and Hajime Takikawa and Hiromi Ishibashi and Shinji Shimoda and Shotaro Sakisaka and Makoto Nakamuta and Yasushi Matsuzaki and Toshiji Saibara and Yoshiyuki Ueno and Hiroshi Miyakawa and Norihiro Kokudo and Hiroto Egawa and Yoshihiko Maehara and Satoshi Mochida and Isao Sakaida and Tomoo Fujisawa and Kazuyuki Suzuki and Kazuaki Inoue and Takafumi Ichida and Osamu Yokosuka and Hiroshi Fukui and Hisataka Moriwaki and Mitsuru Mori and Toshiyuki Mori and Masato Nagino and Naohiro Sata and Susumu Tazuma and Takahiro Yasaka and Toshio Tsuyuguchi and Junichi Shoda and Masao Honda and Hiroki Yamaue and Michiaki Unno and Norio Hayashi",

year = "2013",

month = jun,

doi = "10.1111/j.1872-034X.2012.01109.x",

language = "English",

volume = "43",

pages = "630--638",

journal = "Hepatology Research",

issn = "1386-6346",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "6",

}

Yamamoto, K, Miyake, Y, Ohira, H, Suzuki, Y, Zeniya, M, Onji, M, Tsubouchi, H, Yoshizawa, K, Morizane, T, Hibi, T, Aoyagi, Y, Nakanuma, Y, Hirohara, J, Takikawa, H, Ishibashi, H, Shimoda, S, Sakisaka, S, Nakamuta, M, Matsuzaki, Y, Saibara, T, Ueno, Y, Miyakawa, H, Kokudo, N, Egawa, H, Maehara, Y, Mochida, S, Sakaida, I, Fujisawa, T, Suzuki, K, Inoue, K, Ichida, T, Yokosuka, O, Fukui, H, Moriwaki, H, Mori, M, Mori, T, Nagino, M, Sata, N, Tazuma, S, Yasaka, T, Tsuyuguchi, T, Shoda, J, Honda, M, Yamaue, H, Unno, M & Hayashi, N 2013, 'Prognosis of autoimmune hepatitis showing acute presentation', Hepatology Research, vol. 43, no. 6, pp. 630-638. https://doi.org/10.1111/j.1872-034X.2012.01109.x

TY - JOUR

T1 - Prognosis of autoimmune hepatitis showing acute presentation

AU - Yamamoto, Kazuhide

AU - Miyake, Yasuhiro

AU - Ohira, Hiromasa

AU - Suzuki, Yoshiyuki

AU - Zeniya, Mikio

AU - Onji, Morikazu

AU - Tsubouchi, Hirohito

AU - Yoshizawa, Kaname

AU - Morizane, Toshio

AU - Hibi, Toshifumi

AU - Aoyagi, Yutaka

AU - Nakanuma, Yasuni

AU - Hirohara, Junko

AU - Takikawa, Hajime

AU - Ishibashi, Hiromi

AU - Shimoda, Shinji

AU - Sakisaka, Shotaro

AU - Nakamuta, Makoto

AU - Matsuzaki, Yasushi

AU - Saibara, Toshiji

AU - Ueno, Yoshiyuki

AU - Miyakawa, Hiroshi

AU - Kokudo, Norihiro

AU - Egawa, Hiroto

AU - Maehara, Yoshihiko

AU - Mochida, Satoshi

AU - Sakaida, Isao

AU - Fujisawa, Tomoo

AU - Suzuki, Kazuyuki

AU - Inoue, Kazuaki

AU - Ichida, Takafumi

AU - Yokosuka, Osamu

AU - Fukui, Hiroshi

AU - Moriwaki, Hisataka

AU - Mori, Mitsuru

AU - Mori, Toshiyuki

AU - Nagino, Masato

AU - Sata, Naohiro

AU - Tazuma, Susumu

AU - Yasaka, Takahiro

AU - Tsuyuguchi, Toshio

AU - Shoda, Junichi

AU - Honda, Masao

AU - Yamaue, Hiroki

AU - Unno, Michiaki

AU - Hayashi, Norio

PY - 2013/6

Y1 - 2013/6

N2 - Aim: The number of patients with autoimmune hepatitis (AIH) showing acute presentation has increased. This study aimed to assess their prognosis. Methods: A survey of AIH patients by sending questionnaires was performed, and 96 patients showing acute presentation were investigated. Results: The median age was 58 years and 78 patients (81%) were female. Eighty-four patients (88%) were positive for antinuclear antibody and/or anti-smooth muscle antibody. The median serum immunoglobulin G level was 2252mg/dL. Twenty-five patients (26%) showed histological acute hepatitis. As initial treatment, 88 patients (92%) were treated with corticosteroid, and 28 of them received pulse steroid treatment. Overall, 11 patients (11%) reached fatal outcomes (nine death and two liver transplantation). Patients with histological acute hepatitis showed higher serum bilirubin levels, lower prothrombin activities and higher prothrombin time-international normalized ratios (PT-INR) and reached fatal outcomes more frequently. With a multivariate logistic regression analysis, prothrombin activity and PT-INR at presentation was associated with fatal outcomes. Nine of 13 patients (69%) showing prothrombin activity of 40% or lower at presentation and nine of 19 patients (47%) showing PT-INR of 1.5 or higher reached fatal outcomes. Furthermore, of 13 patients showing prothrombin activity of 40% or lower and/or PT-INR of 1.5 or higher at presentation who were treated with pulse steroid treatment, four (31%) died from infectious disease. Conclusion: Prothrombin activity and PT-INR are prognostic factors for AIH showing acute presentation. Physicians should pay attention to the development of infectious disease when pulse steroid treatment is performed.

AB - Aim: The number of patients with autoimmune hepatitis (AIH) showing acute presentation has increased. This study aimed to assess their prognosis. Methods: A survey of AIH patients by sending questionnaires was performed, and 96 patients showing acute presentation were investigated. Results: The median age was 58 years and 78 patients (81%) were female. Eighty-four patients (88%) were positive for antinuclear antibody and/or anti-smooth muscle antibody. The median serum immunoglobulin G level was 2252mg/dL. Twenty-five patients (26%) showed histological acute hepatitis. As initial treatment, 88 patients (92%) were treated with corticosteroid, and 28 of them received pulse steroid treatment. Overall, 11 patients (11%) reached fatal outcomes (nine death and two liver transplantation). Patients with histological acute hepatitis showed higher serum bilirubin levels, lower prothrombin activities and higher prothrombin time-international normalized ratios (PT-INR) and reached fatal outcomes more frequently. With a multivariate logistic regression analysis, prothrombin activity and PT-INR at presentation was associated with fatal outcomes. Nine of 13 patients (69%) showing prothrombin activity of 40% or lower at presentation and nine of 19 patients (47%) showing PT-INR of 1.5 or higher reached fatal outcomes. Furthermore, of 13 patients showing prothrombin activity of 40% or lower and/or PT-INR of 1.5 or higher at presentation who were treated with pulse steroid treatment, four (31%) died from infectious disease. Conclusion: Prothrombin activity and PT-INR are prognostic factors for AIH showing acute presentation. Physicians should pay attention to the development of infectious disease when pulse steroid treatment is performed.

KW - Acute presentation

KW - Autoimmune hepatitis

KW - Prothrombin activity

KW - Prothrombin time-international normalized ratio

KW - Pulse steroid treatment

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UR - http://www.scopus.com/inward/citedby.url?scp=84878781342&partnerID=8YFLogxK

U2 - 10.1111/j.1872-034X.2012.01109.x

DO - 10.1111/j.1872-034X.2012.01109.x

M3 - Article

AN - SCOPUS:84878781342

SN - 1386-6346

VL - 43

SP - 630

EP - 638

JO - Hepatology Research

JF - Hepatology Research

IS - 6

ER -

Prognosis of autoimmune hepatitis showing acute presentation

Abstract

Keywords

UN SDGs

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