1. Hepatic Steatosis in patients with Autoimmune Hepatitis (AIH) – prevalence, progression and possible significance C. Salmon*1, B.Hoeroldt2, A. Dube3, E.McFarlane1,
D. Gleeson1. 1Liver Unit and 3 Histopathology Department, Royal Hallamshire Hospital, Sheffield, UK. 2Gastroenterology Department, Rotherham General Hospital, Rotherham, UK
Introduction:
A link between steatosis and Prednisolone therapy has been suggested, but is poorly documented. In Hepatitis C, steatosis is associated with genotype 3, high viral replication, poor response to treatment and fibrosis proression. Little is known about steatosis in Autoimmune Hepatitis (AIH).
Results 2:
On biopsy in remission, 50 of the 109 patients had steatosis, which had appeared or worsened in 35 patients. In 6 patients steatosis disappeared and 31 patients developed new steatosis. Steatosis grade worsened between diagnostic and follow up biopsy (p<0.001 by M-W). Worsening of steatosis was not related to gender, age, diabetes, or body weight or to duration, initial dose or maintenance dose of Prednisolone.
Results 3:
Fibrosis score improved with treatment in the cohort as a whole (p<0.01). Although improvement was less in patients with worsening steatosis (n=31), compared to those with stable steatosis (n=76), the difference was not significant. On regression analysis, change in fibrosis score with treatment was associated with NI score on follow-up biopsy (<0.0001) and with Body Weight (P=0.046) but not with either presence or worsening of steatosis.
Aim:
To assess the prevalence, progression and significance of steatosis in AIH.
Patients and methods:
109 patients with AIH, 18 men, median age 53 (9 -85) years, 37 probable, 75 definite by IAIHG criteria. We assessed steatosis (grade 1-3 and distribution), Ishak necro-inflammatory (NI) score and Ishak fibrosis score in paired liver biopsies: the initial diagnostic biopsy and a follow up biopsy when in remission after median 25 (3-115) months Prednisolone. Inter-group comparison (Mann-Whitney test) and Cox regression analysis were performed using SPSS.
Results 1:
Comparison of patients with and without steatosis on initial biopsy. Range(median)
Fibrosis stage on remission biopsy was associated with fibrosis stage on initial biopsy (p<0.001) and with NI score on remission biopsy (p<0.001) . The association with worsening steatosis, reported in abstract was no longer significant.
No steatosis
N=84
Steatosis
N=25
P value
Age
9-77 (48)
20-84 (58)
P=0.005
NI score
1-18 (12)
1-17 (8)
P=0.002
Diabetes
10 (12%)
12 (48%)
P=0.00
IAIHG score
11-25 (17)
13-24 (16)
P=0.950
Histology AIH grade
0-5 (4)
-2-5 (3)
P=0.094
Weight
(68.1)
(70)
P=0.641
Fibrosis
0-6 (3)
P=0.394
Conclusions:
Steatosis is found in ¼ of patients with AIH and is related to age and diabetes.
Steatosis worsens in 1/3 of patients treated with Prednisolone.
There was no association with dose or duration of Prednisolone.
There was no significant association with fibrosis progression.