PMID- 17668882
OWN - NLM
STAT- MEDLINE
DCOM- 20071130
LR  - 20131121
IS  - 0270-9139 (Print)
IS  - 0270-9139 (Linking)
VI  - 46
IP  - 4
DP  - 2007 Oct
TI  - Features associated with treatment failure in type 1 autoimmune hepatitis and 
      predictive value of the model of end-stage liver disease.
PG  - 1138-45
AB  - Autoimmune hepatitis may fail to respond to corticosteroid therapy, but the 
      frequency and bases for this outcome are uncertain. We aimed to determine the 
      frequency and nature of treatment failure in patients with type 1 autoimmune 
      hepatitis, define features associated with its occurrence, and assess if the 
      model for end-stage liver disease can predict this outcome. Patients failing 
      conventional corticosteroid regimens were compared to patients who responded to 
      similar regimens. Fourteen of 214 patients (7%) failed corticosteroid treatment. 
      Patients who failed therapy were younger (33 +/- 3 years versus 48 +/- 1 years, P 
      = 0.0008), had higher serum levels of bilirubin at accession (4.1 +/- 0.9 mg/dL 
      versus 2.3 +/- 0.2 mg/dL, P = 0.02), presented acutely more frequently (43% 
      versus 14%, P = 0.01), and had a higher frequency of HLA (human leukocyte 
      antigen) DRB1*03 (93% versus 53%, P = 0.004) than did patients who achieved 
      remission. An alternative disease (fatty liver disease) emerged in only 1 patient 
      who failed therapy (7%). Scores determined by the model of end-stage liver 
      disease at presentation of patients who failed treatment were higher than those 
      of who achieved remission (16 +/- 1 versus 10 +/- 0.3 points, P < 0.0001), and 
      score greater than 12 points had greater sensitivity (97%) and specificity (68%) 
      for treatment failure than did HLA DRB1*03 or other features. CONCLUSION: Onset 
      at an early age, acute presentation, hyperbilirubinemia, and presence of HLA 
      DRB1*03 characterize patients who fail corticosteroid treatment. The model for 
      end-stage liver disease may be a useful instrument for identifying patients prone 
      to this outcome.
FAU - Montano-Loza, Aldo J
AU  - Montano-Loza AJ
AD  - Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 
      Rochester, MN 55905, USA.
FAU - Carpenter, Herschel A
AU  - Carpenter HA
FAU - Czaja, Albert J
AU  - Czaja AJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Hepatology
JT  - Hepatology (Baltimore, Md.)
JID - 8302946
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Antiviral Agents)
RN  - 0 (HLA-DR Antigens)
RN  - 0 (HLA-DRB1 Chains)
RN  - RFM9X3LJ49 (Bilirubin)
SB  - IM
MH  - Adolescent
MH  - Adrenal Cortex Hormones/*therapeutic use
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antiviral Agents/*therapeutic use
MH  - Bilirubin/blood
MH  - Disease Progression
MH  - Female
MH  - HLA-DR Antigens/*blood
MH  - HLA-DRB1 Chains
MH  - Hepatitis, Autoimmune/*complications/*drug therapy/immunology
MH  - Humans
MH  - Liver/metabolism/pathology
MH  - Liver Failure/*immunology/pathology
MH  - Male
MH  - Middle Aged
MH  - *Models, Biological
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sensitivity and Specificity
MH  - Treatment Outcome
EDAT- 2007/08/03 09:00
MHDA- 2007/12/06 09:00
CRDT- 2007/08/03 09:00
PHST- 2007/08/03 09:00 [pubmed]
PHST- 2007/12/06 09:00 [medline]
PHST- 2007/08/03 09:00 [entrez]
AID - 10.1002/hep.21787 [doi]
PST - ppublish
SO  - Hepatology. 2007 Oct;46(4):1138-45. doi: 10.1002/hep.21787.