Lin, S;
Araujo, C;
Hall, A;
Kumar, R;
Phillips, A;
Hassan, M;
Engelmann, C;
... Jalan, R; + view all
(2021)
Presence of multilobular necrosis on liver biopsy identifies corticosteroid responsiveness in acute indeterminate hepatitis.
Liver International
10.1111/liv.15144.
(In press).
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Abstract
BACKGROUND AND AIMS: Treatment of patients with severe indeterminate hepatitis (IAH) is an unmet need. Corticosteroids are often used in the management of these patients but criteria for selection of patients for this intervention are arbitrary. The aims of this study were to analyze the clinical and pathological features of patients with IAH to define predictors of corticosteroid responsiveness. METHODS: This study included consecutive patients with acute indeterminate hepatitis admitted to a single hospital and underwent a liver biopsy. The clinical manifestation and histopathological features of steroid and non-steroid groups were compared and their relationship with corticosteroids response was evaluated. RESULTS: Forty-eight patients were included, 24 (50%) recovered and the other half underwent liver transplantation or died within 3-months. Of the 48 cases, 24 received corticosteroids (initial dose of 45 ± 12 mg prednisolone). Corticosteroids were initiated 2.7 ± 3.8 days after admission. Liver biopsy was performed 2-days (median, IQR 1-3) after admission. Fifteen (62.5%) patients receiving corticosteroids survived without transplantation compared with 9 (37.5%) that did not receive steroids (p= 0.149). In those with multilobular necrosis, 50% reduction in the death/transplantation rate was observed after steroid treatment (p=0.018). In patients without multilobular necrosis and with or without perivenulitis, corticosteroids did not impact outcome. Response to corticosteroids was independent of the MELD score. CONCLUSIONS: The presence of multilobular necrosis on liver biopsy helps identify a subgroup of IAH cases who may be benefit from administration of corticosteroids.
| Type: | Article |
|---|---|
| Title: | Presence of multilobular necrosis on liver biopsy identifies corticosteroid responsiveness in acute indeterminate hepatitis |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/liv.15144 |
| Publisher version: | https://doi.org/10.1111/liv.15144 |
| Language: | English |
| Additional information: | This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third-party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ |
| Keywords: | Biopsy, corticosteroid, indeterminate hepatitis, necrosis, pathology |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10141842 |
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