Title :

Early liver transplantation for corticosteroid non-responders in acute severe autoimmune hepatitis: the surfasa score

Author(s) :

De Martin, Eleonora [Auteur]
Centre Hépato-Biliaire [Hôpital Paul Brousse] [CHB]
Chazouilleres, Olivier [Auteur]
CHU Saint-Antoine [AP-HP]
Roux, Olivier [Auteur]
Hôpital Beaujon [AP-HP]
Peron, Jean-Marie [Auteur]
Centre Hospitalier Universitaire de Toulouse [CHU Toulouse]
Houssel-Debry, Pauline [Auteur]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Artru, Florent [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Silvain, Christine [Auteur]
Centre hospitalier universitaire de Poitiers = Poitiers University Hospital [CHU de Poitiers [La Milétrie]]
Ollivier-Hourmand, Isabelle [Auteur]
Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen]
Duvoux, Christophe [Auteur]
Service d'hépato-gastro-entérologie [APHP Henri Mondor]
Heurgue-Berlot, Alexandra [Auteur]
Hôpital universitaire Robert Debré [Reims] [CHU Reims]
Barge, Sandrine [Auteur]
Ganne-Carrie, Nathalie [Auteur]
Hôpital Jean Verdier [AP-HP]
Pageaux, Georges-Philippe [Auteur]
Département d'Hépato-Gastroentérologie et de Transplantation Hépatique [CHU Saint-Eloi]
Besch, Camille [Auteur]

Bourliere, Marc [Auteur]
Hôpital Saint-Joseph [Marseille]
Fontaine, Helene [Auteur]
Département d'hépatologie [CHU Cochin]
De Ledinghen, Victor [Auteur]
Centre Hospitalier Universitaire de Bordeaux [CHU Bordeaux]
Dumortier, Jerome [Auteur]
Hôpital Edouard Herriot [CHU - HCL]
Conti, Filomena [Auteur]
CHU Pitié-Salpêtrière [AP-HP]
Radenne, Sylvie [Auteur]
Service d'Hépatologie [Hôpital de la Croix-Rousse - HCL]
Debette-Gratien, Maryline [Auteur]
Service d'Hépato-gastro-entérologie et Nutrition [CHU Dupuytren 1, Limoges]
Goria, Odile [Auteur]
Service d'Hépato-Gastroentérologie [CHU Rouen]
Durand, Francois [Auteur]
Hôpital Beaujon [AP-HP]
Potier, Pascal [Auteur]
Centre Hospitalier Régional d'Orléans [CHRO]
Di Martino, Vincent [Auteur]
Hôpital JeanMinjoz
Reboux, Noemi [Auteur]
Centre Hospitalier Régional Universitaire de Brest [CHRU Brest]
Ichai, Philippe [Auteur]
Centre Hépato-Biliaire [Hôpital Paul Brousse] [CHB]
Sebagh, Mylene [Auteur]
Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
Mathurin, Philippe [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Agostini, Helene [Auteur]
Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
Samuel, Didier [Auteur]
Centre Hépato-Biliaire [Hôpital Paul Brousse] [CHB]
Duclos-Vallee, Jean-Charles [Auteur]
Centre Hépato-Biliaire [Hôpital Paul Brousse] [CHB]

Journal title :

Journal of hepatology

Abbreviated title :

J Hepatol

Publication date :

2021-01-24

ISSN :

1600-0641

Keyword(s) :

Severe acute hepatitis
liver transplantation
autoimmune hepatitis
corticosteroid therapy
prognostic score

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

OBJECTIVE: In acute severe autoimmune hepatitis (AS-AIH), the optimal timing for liver transplantation (LT) remains controversial. The objectives of this study were to determine early predictive factors for a non-response ...
Show more >OBJECTIVE: In acute severe autoimmune hepatitis (AS-AIH), the optimal timing for liver transplantation (LT) remains controversial. The objectives of this study were to determine early predictive factors for a non-response to corticosteroids and to propose a score to identify patients in whom LT is urgently indicated. METHODS: This was a retrospective, multicenter study (2009-2016). A diagnosis of AS-AIH was based on: i) Definite or probable AIH based on the simplified IAIHG score; ii) international normalized ratio (INR) ≥1.5 and/or bilirubin >200 μmol/L; iii) No previous history of AIH; iv) Histologically proven AIH. A treatment response was defined as LT-free survival at 90 days. The evolution of variables from corticosteroid initiation (day-D0) to D3 was estimated from: Δ%3 = (D3-D0)/D0. RESULTS: A total of 128 patients were included, with a median age of 52 (39-62) years; 72% were female. Overall survival reached 88%. One hundred and fifteen (90%) patients received corticosteroids, with a LT-free survival rate of 66% at 90 days. Under multivariate analysis, D0-INR (odds ratio [OR] 6.85; 95% CI 2.23-21.06; p <0.001), Δ%3-INR ≥0.1% (OR 6.97; 95% CI 1.59-30.46; p <0.01) and Δ%3-bilirubin ≥-8% (OR 5.14; 95% CI 1.09-24.28; p <0.04) were predictive of a non-response. The SURFASA score: -6.80+1.92∗(D0-INR)+1.94∗(Δ%3-INR)+1.64∗(Δ%3-bilirubin), created by combining these variables, was highly predictive of LT or death (AUC = 0.93) (88% specificity; 84% sensitivity) with a cut-off point of <-0.9. Below this cut-off, the chance of responding was 75%. With a score higher than 1.75, the risk of dying or being transplanted was between 85% and 100%. CONCLUSIONS: In patients with AS-AIH, INR at the introduction of corticosteroids and the evolution of INR and bilirubin are predictive of LT or death. Within 3 days of initiating corticosteroids, the SURFASA score can identify non-responders who require a referral for LT. This score needs to be validated in a prospective cohort. The management of patients with acute severe autoimmune hepatitis is highly challenging, particularly regarding their early referral for liver transplantation. We found that international normalized ratio at the initiation of corticosteroid therapy and the evolution of international normalized ratio and bilirubin values after 3 days of therapy were highly predictive of liver transplantation or death. We are thus proposing a score that combines these variables and identifies patients in whom liver transplantation is urgently required.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Inserm
Université de Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Submission date :

2021-07-06T12:51:05Z
2024-01-30T12:32:11Z