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Natural History of Patients Presenting with Autoimmune Hepatitis and Coincident Nonalcoholic Fatty Liver Disease

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Abstract

Background

Given the increase of nonalcoholic fatty liver disease (NAFLD) in the general population, a similar rise might be expected in autoimmune hepatitis (AIH) patients.

Aims

We sought to determine the clinical outcome of patients with coincident AIH and NAFLD.

Methods

We identified all intradepartmental AIH cases, and those meeting study criteria were placed into one of three cohorts: AIH only, AIH and simple steatosis (SS), and AIH and nonalcoholic steatohepatitis (NASH). The following outcome and clinical data were analyzed: incidence of all-cause mortality, incidence of liver-related mortality, incidence of liver-related adverse outcomes, and prevalence of cirrhosis at index biopsy.

Results

Out of a total 73 study patients, 14 % classified as AIH with SS and 16 % as AIH and NASH. Fifty percent of AIH and NASH patients had cirrhosis at index biopsy as compared to 18 % of AIH-only patients (p = 0.032). Patients with AIH and NASH had a relative risk of 7.65 (95 % CI 1.43–40.8) for liver-related mortality and 2.55 (95 % CI 0.92–7.09) for liver-related adverse outcomes, as compared to the AIH-only cohort. No significant difference in outcome measures existed in comparing (AIH only) with (AIH and SS) cohorts.

Discussion

Patients with coincident AIH and NASH were more likely to present with cirrhosis and more likely to develop adverse clinical outcome with decreased survival as compared to AIH-only patients. These findings suggest that simultaneous exposure confers a clinically significant increased risk, which may warrant closer follow-up and surveillance.

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Acknowledgments

Preliminary histologic findings were reported as a platform presentation at the 2013 annual meeting of the United States and Canadian Academy of Pathology (Baltimore, MD, March 4, 2013). Clinical outcome data were reported as a poster presentation at the 2015 annual meeting of the United States and Canadian Academy of Pathology (Boston, MA, March 25, 2015).

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, 89 Beaumont Avenue, Courtyard at Given S269, Burlington, VT, 05405, USA

    Javier De Luca-Johnson & Rebecca Wilcox

  2. Division of Gastroenterology, Department of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Kirk J. Wangensteen

  3. Department of Pathology, University of New Mexico, Reginald Heber Fitz Hall, Room 335, 915 Camino de Salud, Albuquerque, NM, 87131, USA

    Joshua Hanson

  4. Department of Medicine, University of Vermont Medical Center, 111 Colchester Avenue, Fletcher 311, Burlington, VT, 05401, USA

    Kirk J. Wangensteen & Edward Krawitt

Authors
  1. Javier De Luca-Johnson
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  2. Kirk J. Wangensteen
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  3. Joshua Hanson
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Corresponding author

Correspondence to Javier De Luca-Johnson.

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De Luca-Johnson, J., Wangensteen, K.J., Hanson, J. et al. Natural History of Patients Presenting with Autoimmune Hepatitis and Coincident Nonalcoholic Fatty Liver Disease. Dig Dis Sci 61, 2710–2720 (2016). https://doi.org/10.1007/s10620-016-4213-3

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  • DOI: https://doi.org/10.1007/s10620-016-4213-3

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