Clinical profile of Autoimmune hepatitis related decompensated Cirrhosis and their treatment outcomes: A study from Western India

Abstract

Background: Our study was undertaken to analyse the clinical profile and management strategies of patients having AIH related decompensated cirrhosis in a non-transplant resource limited setting from western India. The parameters analysed were the demographic profile ,1 year transplant-free survival ,occurrence of infections and changes in CTP and MELD scores at the end of one year in patients with AIH related decompensated cirrhosis .

Methods: In the retrospective data collected from January 2017 to December 2020 ,patients with AIH related decompensated cirrhosis were treated with steroids with/without immunomodulators using a predetermined treatment protocol. The demographic data, types of presentation, treatment imparted, response, changes in CTP, MELD and survival at the end of one year was studied.

Results: Thirty-five patients with AIH related decompensated cirrhosis were studied. The mean age was 45.4 + 14.6 years and female to male ratio was 1.2:1. Ascites (91.4%) was the most common form of decompensating event at presentation. Twenty-eight patients received treatment with immunosuppressants. The overall survival rate was 85.7% at the end of one year. The most common cause of death was sepsis with spontaneous bacterial peritonitis (SBP) being the most common form of infection .Encephalopathy on presentation was a significant factor leading to mortality in our study (p=0.0001).

There was no significant difference in the change in MELD, survival rates or rates of infections based on the treatment received by the patient of AIH.

Conclusion: In a non-transplant resource limited setting, immunosuppressive therapy did not improve survival in patients with AIH related decompensated cirrhosis.