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Histological activity despite normal ALT and IgG serum levels in patients with autoimmune hepatitis and cirrhosis

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Histological activity despite normal ALT and IgG serum levels in patients with autoimmune hepatitis and cirrhosis. / Laschtowitz, Alena; Zachou, Kalliopi; Lygoura, Vasiliki; Pape, Simon; Derben, Finn; Jaeckel, Elmar; Oller-Moreno, Sergio; Weidemann, Sören; Krech, Till; Piecha, Felix; Schön, Gerhard; Liebhoff, Anna-Maria; Al Tarrah, Munira; Heneghan, Michael; Drenth, Joost P H; Dalekos, George; Taubert, Richard; Lohse, Ansgar Wilhelm; Schramm, Christoph.

in: JHEP REP, Jahrgang 3, Nr. 4, 08.2021, S. 100321.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Laschtowitz, A, Zachou, K, Lygoura, V, Pape, S, Derben, F, Jaeckel, E, Oller-Moreno, S, Weidemann, S, Krech, T, Piecha, F, Schön, G, Liebhoff, A-M, Al Tarrah, M, Heneghan, M, Drenth, JPH, Dalekos, G, Taubert, R, Lohse, AW & Schramm, C 2021, 'Histological activity despite normal ALT and IgG serum levels in patients with autoimmune hepatitis and cirrhosis', JHEP REP, Jg. 3, Nr. 4, S. 100321. https://doi.org/10.1016/j.jhepr.2021.100321

APA

Laschtowitz, A., Zachou, K., Lygoura, V., Pape, S., Derben, F., Jaeckel, E., Oller-Moreno, S., Weidemann, S., Krech, T., Piecha, F., Schön, G., Liebhoff, A-M., Al Tarrah, M., Heneghan, M., Drenth, J. P. H., Dalekos, G., Taubert, R., Lohse, A. W., & Schramm, C. (2021). Histological activity despite normal ALT and IgG serum levels in patients with autoimmune hepatitis and cirrhosis. JHEP REP, 3(4), 100321. https://doi.org/10.1016/j.jhepr.2021.100321

Vancouver

Laschtowitz A, Zachou K, Lygoura V, Pape S, Derben F, Jaeckel E et al. Histological activity despite normal ALT and IgG serum levels in patients with autoimmune hepatitis and cirrhosis. JHEP REP. 2021 Aug;3(4):100321. https://doi.org/10.1016/j.jhepr.2021.100321

Bibtex

@article{0b3bdb868f984b349f7845748d97e661,
title = "Histological activity despite normal ALT and IgG serum levels in patients with autoimmune hepatitis and cirrhosis",
abstract = "Background & Aims: In autoimmune hepatitis (AIH), normal levels of transaminases and IgG define biochemical remission and are considered the best surrogate markers for histological remission. This study assessed whether this also applies to patients with AIH cirrhosis.Methods: In this European multicentric study, we included 125 biopsies from 113 patients with AIH and histologically proven cirrhosis; 105 biopsies from 104 patients with AIH without cirrhosis served as controls. Biochemical parameters were available within 4 weeks of biopsy. AIH activity was graded according to the modified Hepatitis Activity Index (mHAI), with mHAI ≥4/18 considered to indicate risk of disease progression.Results: In total, 47 out of 125 liver biopsies were obtained from patients with AIH cirrhosis and normal ALT levels at time of biopsy. Only 26% (12/47) of those livers showed histological remission (mHAI <4/18), whereas 36% (17/47) showed moderate to high histological activity (mHAI ≥6/18). In patients with noncirrhotic AIH, 88% (46/52 biopsies) of cases with normal ALT levels had histological remission and only 4% (2/52) had an mHAI ≥6/18 (p <0.001). The addition of IgG to define complete biochemical remission only slightly improved the association with histological remission in the limited number of patients with AIH cirrhosis available for analysis [29% (5/17) of biopsies with mHAI <4/18]. ALT correlated closely with mHAI in AIH without cirrhosis but poorly in AIH with cirrhosis.Conclusions: In contrast to patients with noncirrhotic AIH, in patients with AIH cirrhosis, who are at risk of disease progression, normal ALT levels and potentially also complete biochemical remission are poor surrogate markers of histological remission. Thus, new biomarkers are needed to monitor disease activity and progression in patients with AIH cirrhosis.Lay summary: Autoimmune hepatitis (AIH) is an inflammatory disease of the liver that usually responds to immunosuppressive therapy. Serum transaminases and IgG levels within the normal ranges define complete biochemical remission and are considered as surrogate markers for histological disease activity. Here, we show that those biochemical markers are not sufficient to indicate low disease activity in patients with AIH and already established cirrhosis. Consequently, until better biomarkers for disease activity are found, only liver biopsy can reliably indicate disease activity in the presence of cirrhosis. Additional investigations, such as measurements of liver stiffness, should be undertaken to monitor non-invasively for disease progression in patients with AIH and established cirrhosis.",
author = "Alena Laschtowitz and Kalliopi Zachou and Vasiliki Lygoura and Simon Pape and Finn Derben and Elmar Jaeckel and Sergio Oller-Moreno and S{\"o}ren Weidemann and Till Krech and Felix Piecha and Gerhard Sch{\"o}n and Anna-Maria Liebhoff and {Al Tarrah}, Munira and Michael Heneghan and Drenth, {Joost P H} and George Dalekos and Richard Taubert and Lohse, {Ansgar Wilhelm} and Christoph Schramm",
note = "{\textcopyright} 2021 The Authors.",
year = "2021",
month = aug,
doi = "10.1016/j.jhepr.2021.100321",
language = "English",
volume = "3",
pages = "100321",
journal = "JHEP REP",
issn = "2589-5559",
publisher = "Elsevier",
number = "4",

}

RIS

TY - JOUR

T1 - Histological activity despite normal ALT and IgG serum levels in patients with autoimmune hepatitis and cirrhosis

AU - Laschtowitz, Alena

AU - Zachou, Kalliopi

AU - Lygoura, Vasiliki

AU - Pape, Simon

AU - Derben, Finn

AU - Jaeckel, Elmar

AU - Oller-Moreno, Sergio

AU - Weidemann, Sören

AU - Krech, Till

AU - Piecha, Felix

AU - Schön, Gerhard

AU - Liebhoff, Anna-Maria

AU - Al Tarrah, Munira

AU - Heneghan, Michael

AU - Drenth, Joost P H

AU - Dalekos, George

AU - Taubert, Richard

AU - Lohse, Ansgar Wilhelm

AU - Schramm, Christoph

N1 - © 2021 The Authors.

PY - 2021/8

Y1 - 2021/8

N2 - Background & Aims: In autoimmune hepatitis (AIH), normal levels of transaminases and IgG define biochemical remission and are considered the best surrogate markers for histological remission. This study assessed whether this also applies to patients with AIH cirrhosis.Methods: In this European multicentric study, we included 125 biopsies from 113 patients with AIH and histologically proven cirrhosis; 105 biopsies from 104 patients with AIH without cirrhosis served as controls. Biochemical parameters were available within 4 weeks of biopsy. AIH activity was graded according to the modified Hepatitis Activity Index (mHAI), with mHAI ≥4/18 considered to indicate risk of disease progression.Results: In total, 47 out of 125 liver biopsies were obtained from patients with AIH cirrhosis and normal ALT levels at time of biopsy. Only 26% (12/47) of those livers showed histological remission (mHAI <4/18), whereas 36% (17/47) showed moderate to high histological activity (mHAI ≥6/18). In patients with noncirrhotic AIH, 88% (46/52 biopsies) of cases with normal ALT levels had histological remission and only 4% (2/52) had an mHAI ≥6/18 (p <0.001). The addition of IgG to define complete biochemical remission only slightly improved the association with histological remission in the limited number of patients with AIH cirrhosis available for analysis [29% (5/17) of biopsies with mHAI <4/18]. ALT correlated closely with mHAI in AIH without cirrhosis but poorly in AIH with cirrhosis.Conclusions: In contrast to patients with noncirrhotic AIH, in patients with AIH cirrhosis, who are at risk of disease progression, normal ALT levels and potentially also complete biochemical remission are poor surrogate markers of histological remission. Thus, new biomarkers are needed to monitor disease activity and progression in patients with AIH cirrhosis.Lay summary: Autoimmune hepatitis (AIH) is an inflammatory disease of the liver that usually responds to immunosuppressive therapy. Serum transaminases and IgG levels within the normal ranges define complete biochemical remission and are considered as surrogate markers for histological disease activity. Here, we show that those biochemical markers are not sufficient to indicate low disease activity in patients with AIH and already established cirrhosis. Consequently, until better biomarkers for disease activity are found, only liver biopsy can reliably indicate disease activity in the presence of cirrhosis. Additional investigations, such as measurements of liver stiffness, should be undertaken to monitor non-invasively for disease progression in patients with AIH and established cirrhosis.

AB - Background & Aims: In autoimmune hepatitis (AIH), normal levels of transaminases and IgG define biochemical remission and are considered the best surrogate markers for histological remission. This study assessed whether this also applies to patients with AIH cirrhosis.Methods: In this European multicentric study, we included 125 biopsies from 113 patients with AIH and histologically proven cirrhosis; 105 biopsies from 104 patients with AIH without cirrhosis served as controls. Biochemical parameters were available within 4 weeks of biopsy. AIH activity was graded according to the modified Hepatitis Activity Index (mHAI), with mHAI ≥4/18 considered to indicate risk of disease progression.Results: In total, 47 out of 125 liver biopsies were obtained from patients with AIH cirrhosis and normal ALT levels at time of biopsy. Only 26% (12/47) of those livers showed histological remission (mHAI <4/18), whereas 36% (17/47) showed moderate to high histological activity (mHAI ≥6/18). In patients with noncirrhotic AIH, 88% (46/52 biopsies) of cases with normal ALT levels had histological remission and only 4% (2/52) had an mHAI ≥6/18 (p <0.001). The addition of IgG to define complete biochemical remission only slightly improved the association with histological remission in the limited number of patients with AIH cirrhosis available for analysis [29% (5/17) of biopsies with mHAI <4/18]. ALT correlated closely with mHAI in AIH without cirrhosis but poorly in AIH with cirrhosis.Conclusions: In contrast to patients with noncirrhotic AIH, in patients with AIH cirrhosis, who are at risk of disease progression, normal ALT levels and potentially also complete biochemical remission are poor surrogate markers of histological remission. Thus, new biomarkers are needed to monitor disease activity and progression in patients with AIH cirrhosis.Lay summary: Autoimmune hepatitis (AIH) is an inflammatory disease of the liver that usually responds to immunosuppressive therapy. Serum transaminases and IgG levels within the normal ranges define complete biochemical remission and are considered as surrogate markers for histological disease activity. Here, we show that those biochemical markers are not sufficient to indicate low disease activity in patients with AIH and already established cirrhosis. Consequently, until better biomarkers for disease activity are found, only liver biopsy can reliably indicate disease activity in the presence of cirrhosis. Additional investigations, such as measurements of liver stiffness, should be undertaken to monitor non-invasively for disease progression in patients with AIH and established cirrhosis.

U2 - 10.1016/j.jhepr.2021.100321

DO - 10.1016/j.jhepr.2021.100321

M3 - SCORING: Journal article

C2 - 34381983

VL - 3

SP - 100321

JO - JHEP REP

JF - JHEP REP

SN - 2589-5559

IS - 4

ER -