Otoimmün Hepatit Nedeniyle Takipli Hastaların Tedaviye Yanıt Durumları ve Yanıtı Belirleyen Faktörlerin Değerlendirilmesi

Abstract

Jaiteh, M. B. Assessment of treatment outcomes and factors associated with remission in autoimmune hepatitis. Hacettepe University Medical School, Thesis for Residency Completion in Internal Medicine, Ankara, 2019. Aim: We aimed to establish the baseline features and treatment outcomes as well as factors associated with remission in autoimmune hepatitis (AIH) patients. Materials and Method: We analyzed data for 69 autoimmune hepatitis patients being followed at a hospital in Turkey. Aside from a description of baseline characteristics, we also performed a survival analysis to determine remission rates and associated factors. Results: 69.6% of the 69 patients constituted females while median age at diagnosis was 42 years. The great majority (92.8%) were consistent with Type 1 AIH. One-third had at least one extrahepatic autoimmune disease mostly autoimmune thyroid diseases. Overlap syndromes were present in 18.8% and 20.3% were asymptomatic at the time of diagnosis. Male patients had higher baseline ALT, total bilirubin, INR and hemoglobin but a lower platelet count and a lower rate of ANA seropositivity (p<0.05 for each variable). Cirrhotic patients (11.8%) had a statistically significant higher GGT and total bilirubin and a lower albumin level and platelet count than non-cirrhotic patients. Splenomegaly was likewise more common among cirrhotic patients (p<0,05). On the other hand, patients who achieved remission had a higher pre-treatment levels of ALT, AST, INR as well as lower ALP and GGT (p<0.05 for each). The most preferred treatment regimen was corticosteroid-azathiopurine combination (74.5%). In survival analysis, median follow-up period was 56 months with a median remission time of 20 months. Two- and 5-year sustained remission rates were estimated at 40 and 58% respectively. That being said, 24.4% of patients who achieved remission had a relapse in a median of 30 months after remission. Gender, cirrhosis and treatment regimen were not found to be associated with remission. Conclusion: We found a fairly improved median remission time and long-term remission rates in this cohort. While pre-treatment baseline liver tests were associated with remission; gender, cirrhosis, or treatment regimen were not.

Key words: Autoimmune hepatitis, hepatitis, cirrhosis, remission, Turkey