Otoimmün Hepatit Nedeniyle Takipli Hastaların Tedaviye Yanıt Durumları ve Yanıtı Belirleyen Faktörlerin Değerlendirilmesi
Jaiteh, Muhammed B.
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Jaiteh, M. B. Assessment of treatment outcomes and factors associated with remission in autoimmune hepatitis. Hacettepe University Medical School, Thesis for Residency Completion in Internal Medicine, Ankara, 2019. Aim: We aimed to establish the baseline features and treatment outcomes as well as factors associated with remission in autoimmune hepatitis (AIH) patients. Materials and Method: We analyzed data for 69 autoimmune hepatitis patients being followed at a hospital in Turkey. Aside from a description of baseline characteristics, we also performed a survival analysis to determine remission rates and associated factors. Results: 69.6% of the 69 patients constituted females while median age at diagnosis was 42 years. The great majority (92.8%) were consistent with Type 1 AIH. One-third had at least one extrahepatic autoimmune disease mostly autoimmune thyroid diseases. Overlap syndromes were present in 18.8% and 20.3% were asymptomatic at the time of diagnosis. Male patients had higher baseline ALT, total bilirubin, INR and hemoglobin but a lower platelet count and a lower rate of ANA seropositivity (p<0.05 for each variable). Cirrhotic patients (11.8%) had a statistically significant higher GGT and total bilirubin and a lower albumin level and platelet count than non-cirrhotic patients. Splenomegaly was likewise more common among cirrhotic patients (p<0,05). On the other hand, patients who achieved remission had a higher pre-treatment levels of ALT, AST, INR as well as lower ALP and GGT (p<0.05 for each). The most preferred treatment regimen was corticosteroid-azathiopurine combination (74.5%). In survival analysis, median follow-up period was 56 months with a median remission time of 20 months. Two- and 5-year sustained remission rates were estimated at 40 and 58% respectively. That being said, 24.4% of patients who achieved remission had a relapse in a median of 30 months after remission. Gender, cirrhosis and treatment regimen were not found to be associated with remission. Conclusion: We found a fairly improved median remission time and long-term remission rates in this cohort. While pre-treatment baseline liver tests were associated with remission; gender, cirrhosis, or treatment regimen were not. Key words: Autoimmune hepatitis, hepatitis, cirrhosis, remission, Turkey