Potential triggering factors of acute liver failure as a first manifestation of autoimmune hepatitis-a single center experience of 52 adult patients

作     者：Matthias Buechter Paul Manka Falko Markus Heinemann Monika Lindemann Hideo Andreas Baba Martin Schlattjan Ali Canbay Guido Gerken Alisan Kahraman 

作者机构：Department of Gastroenterology and Hepatology University Clinic of Essen Division of Transplantation Immunology and Mucosal Biology King’s CollegeLondon Institute of Transfusion Medicine University Clinic of Essen Institute of Pathology University Clinic of Essen Department of Gastroenterology Hepatology and Infectious Diseases Otto-von-Guericke University 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2018年第24卷第13期

页      面：1410-1418页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Acute liver failure Autoimmune hepatitis Drug-induced liver injury Triggering factors MELD-score 

摘      要：AIM To investigate potential triggering factors leading to acute liver failure(ALF) as the initial presentation of autoimmune hepatitis(AIH).METHODS A total of 565 patients treated at our Department between 2005 and 2017 for histologically-proven AIH were retrospectively analyzed. However, 52 patients(9.2%) fulfilled the criteria for ALF defined by the American Association for the Study of the Liver(AASLD). According to this definition, patients with acute-on-chronic or acute-on-cirrhosis liver failure were excluded. Following parameters with focus on potential triggering factors were evaluated: Patients demographics, causation of liver failure, laboratory data(liver enzymes, MELD-score, autoimmune markers, virus serology), liver histology, immunosuppressive regime, and finally, outcome of our *** The majority of patients with ALF were female(84.6%) and mean age was 43.6 ± 14.9 years. Interestingly, none of the patients with ALF was positive for antiliver kidney microsomal antibody(LKM). We could identify potential triggering factors in 26/52(50.0%) of previously healthy patients presenting ALF as their first manifestation of AIH. These were drug-induced ALF(57.7%), virus-induced ALF(30.8%), and preceding surgery in general anesthesia(11.5%), respectively. Unfortunately, 6 out of 52 patients(11.5%) did not survive ALF and 3 patients(5.7%) underwent liver transplantation(LT). Comparing data of survivors and patients with non-recovery following treatment, MELDscore(P 0.001), age(P 0.05), creatinine(P 0.01), and finally, ALT-values(P 0.05) reached statistical significance. CONCLUSION Drugs, viral infections, and previous surgery may trigger ALF as the initial presentation of AIH. Advanced age and high MELD-score were associated with lethal outcome.