Clinical significance of serum antinuclear antibodies in patients with autoimmune hepatitis and comorbidity

Abstract

Background & Aims: Autoimmune hepatitis (AIH) is often complicated with immune diseases, which greatly affected the course and clinical outcome of AIH. We aimed to systematically assess clinical characteristics, prognosis in autoimmune hepatitis accompanied by immune diseases. Methods: Clinical records of 358 patients with AIH from Beijing Ditan Hospital in China were retrospectively reviewed. The clinical features of AIH with immune diseases were compared retrospectively, including clinical characteristics, prognosis and outcome. Results: Prevalence of immune diseases in patients with AIH was 26.5%. Connective tissue disease (CTD) was the commonest immune diseases associated with AIH (33/358, 9.2%), and the incidence of primary biliary cholangitis (PBC) and thyroid dysfunction (TD) was low (4.7% and 8.5%, respectively). At diagnosis, AIH-PBC patients had higher IgM and ALP, lower weight, Hgb, ALT and AFP (P<0.05). Meanwhile, AIH-CTD patients had lower mean platelet volume, serum K and triglyceride (P<0.05). AIH-TD patients had a lower proportion of ANA positive (P<0.05). The overall survival time of AIH-TD was significantly shorter than AIH patients (P=0.0011), but there were no differences in AIH-PBC and AIH-CTD. Furthermore, ANA negative (HR:0.21, 95%CI 0.13-0.35, P<0.001) can be a factor to predict the poor prognosis of AIH, and also in AIH-TD patients. Conclusions: About 26.5% of AIH patients had at least one immune disease，and TD coexisted with AIH impaired patients’ survival. ANA negative can be used as an independent indicator to predict the poor prognosis of AIH and AIH-TD.

The Outbreak of Unexplained Acute Hepatitis in Children: The Role of Viral Infections in View of the COVID-19 Pandemic

“…Accordingly, some children were treated with steroids and all exhibited rapid declines in liver enzymes. Recently, Liu et al [30] have shown evidence supporting the notion that the cross-reactivity of clonally expanded T cells could be one of the causes of COVID-19-related autoimmune-like hepatitis, including pediatric hepatitis of unknown etiology.…”