Abstract

CORREIA, Lurdes et al. Autoimmune hepatitis: Are simplified criteria less sensitive?. J Port Gastrenterol. [online]. 2013, vol.20, n.4, pp.145-152. ISSN 0872-8178.  https://doi.org/10.1016/j.jpg.2012.10.004.

Introduction: Autoimmune hepatitis (AIH) has variable clinical presentation and recognition can be difficult. The diagnostic criteria of the International AIH Group initially proposed for  scientific purposes, are complex in clinical practice. In 2008, Henes et al. proposed simplified diagnostic criteria (SDC), with positive and negative predictive values of about 90%, but they need further confirmation. Objective: To compare classic and simplified criteria in patients with AIH. Methods: Retrospective analysis of clinical records and application of diagnostic criteria. Results: Included 42 patients (40 females/2 males), with mean age of 38 years old (9-78). Chronic hepatitis was the form of presentation in 66.7%, acute hepatitis in 23.8% and fulminante hepatitis in 9,5%. The majority (91%) had type I HAI and 24% were asymptomatic. Asthenia (64%), jaundice (50%), anorexia (47%), weight loss (31%), arthralgia (29%), hepatomegaly (24%), nausea and vomit (24%) were the most frequent clinical findings; 21% had another autoimmune disease. Patients were treated with prednisolone and azathioprine (45.2%), prednisolone (35.7%) or deflazacort (2,4%); the evolution was favorable in 86% patients, 14% died. In pre-treatment, classic diagnostic criteria classified 25 patients (60%) as definite AIH and 17 (40%) as probable; applying SDC, there was agreement with classic criteria in only19 patients (45%); AIH changed from definite to probable in 14 (33%) and from probable to definite in 3 (7%); in 14% the score was inferior to 6 (definite AIH in 3 and probable in 3, in classic criteria). Conclusions: In our patients, type I AIH (91%) and chronic hepatitis presentation form (66, 7%), were the most frequent. The majority had remission with treatment. Comparison between the diagnostic criteria revealed concordance in 45% of the cases; in 14% the SDC didn’t allow classification as HAI. In practice, faced with suspected HAI, SDC are an initial option, but classical criteria should also be used, particularly in atypical cases.

Keywords : Autoimmune  hepatitis; Diagnosis; Simplified criteria; Diagnostic criteria from the International Autoimmune Hepatitis Group.

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