To Assess Response to Steroids and Transplant Free Survival in Patients with Autoimmune Hepatitis

Background and Aim: In Autoimmune hepatitis (AIH) patients response to steroids and optimal timing of liver transplantation is still a clinical dilemma. In clinical practice to assess response to steroids we monitor bilirubin, SGOT, SGPT, and INR and look for signs of worsening in the form of ascites or encephalopathy. Recently, a SURFASA score was introduced to identify patients who are not responding to steroids at day 3. The aims of the study are: 1) To assess the response to steroids at day 3 from the start of treatment. 2) To validate SURFASA score in Indian AIH patients. Methods: It is an interim analysis of an observational prospective study of 45 patients of AIH divided into: 1) Acute AIH 2) Acute severe (AS-AIH) and 3) Acute on chronic liver failure (ACLF) AIH (according to APASL guideline). Response to steroids was assessed on day 3 using clinical and laboratory parameters. Results: 51.1% (23) of patients presented as Acute AIH, 28.8% (13) as ACLF, and 20% (9) as AS - AIH. Patients (9) who succumbed belonged to the ACLF group. Traditional scores such as CTP and MELD were accurate in predicting response to steroids (p < 0.001). The cutoff of the SURFASA score is <-2.8 in our patients. Conclusion: Patients with Acute and AS-AIH responded to steroids. However, only 30 % of ACLF AIH patients responded to steroids. SURFASA score and traditional scores (CTP and MELD) are accurate in predicting response to steroids and transplant-free survival. The threshold of SURFASA score is different in our population group and so the score needs further validation.