Abstracts of the 2023 Annual Meeting of the ALEH
More infoMetabolic associated liver disease (MAFLD) is one of the most frequent causes of chronic liver disease worldwide. Steatohepatitis is a major risk factor for fibrosis and its progression. MAFLD might be present in other causes of chronic liver damage, such as autoimmune hepatitis (AIH). There is scarce information of the role of MAFLD in fibrosis in patients with AIH. This study aimed to describe frequency of steatosis, steatohepatitis and fibrosis in AIH liver biopsies and the impact of steatosis and steatohepatitis on fibrosis severity and survival.
Materials and MethodsObservational, retrospective study of liver biopsies performed prior to initiation of immunosuppressive therapy, between 2014 and 2019. Presence of steatosis, steatohepatitis and fibrosis was recorded. Alcohol and other etiologies of liver disease were excluded. Clinical data was obtained from electronic charts and outcome variables by telephone contact. Chi2 and exact Fisher test and Odds Ratio (OR) were performed (p < 0.05 considered statistically significant).
Results131 biopsies were analyzed; 76% were female, mean age 56 (15-83) years. Steatosis was present in 27%, steatohepatitis in 14% and advanced fibrosis (≥ F3) in 60%. All patients with steatohepatitis had advanced fibrosis (≥ F3). Presence of steatosis was an independent risk factor for advanced fibrosis (OR 2.97, CI95% 1.22 – 7.21 p = 0.016) and mortality (OR 2.60 (IC95% 1.08 – 6.29), p = 0.033). We performed a sub-analysis including only 66 patients with follow-up were decompensations and hospitalizations were no different between the 2 groups.
ConclusionsIn this cohort of autoimmune hepatitis liver biopsies, steatosis and steatohepatitis were risk factors for advanced fibrosis. All patients with steatohepatitis had advanced liver fibrosis and mortality was higher in patients with steatosis. In patients with AIH, MAFLD should be treated to avoid progression to fibrosis.
