Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis

Pinelopi Arvaniti; Sergio Rodríguez-Tajes; Marlene Padilla; Ignasi Olivas; Ezequiel Mauro; Cautar El Maimouni; Ellina Lytvyak; Xavier Verhelst; Bastian Engel; Richard Taubert; Sara Lorente-Pérez; Isabel Conde; Mar Riveiro-Barciela; Juan-Carlos Ruiz-Cobo; Carmen Álvarez-Navascués; Magdalena Salcedo; Judith Gómez; Maciej K Janik; Beatriz Mateos; Cumali Efe; Alessandro Granito; Elton Datji; Francesco Azzaroli; Diana Horta; Carmen Vila; Inmaculada Castello; Indhira Pérez-Medrano; Ana Arencibia; Alessio Gerussi; Tony Bruns; Francesca Colapierto; Ana Lleo; Natalie Van den Ende; Jef Verbeek; Álvaro Díaz-González; Rosa Ma Morillas; Maria Torner-Simó; Vanesa Bernal; Eva-Maria Fernández; Tom Jg Gevers; Benedetta Terziroli Beretta-Piccoli; Elena Gómez; Paqui Cuenca; Ynte S de Boer; Nanda Kerkar; David N Assis; Rodrigo Liberal; Joost Ph Drenth; Michele M Tana; Marcial Sebode; International Autoimmune Hepatitis Group (IAIHG) collaborators; ERN-Liver; ColHai Registry; Maria-Carlota Londono

doi:10.1016/j.cgh.2025.02.010

Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis

Pinelopi Arvaniti
, Sergio Rodríguez-Tajes
, Marlene Padilla
, Ignasi Olivas
, Ezequiel Mauro
, Cautar El Maimouni
, Ellina Lytvyak
, Xavier Verhelst
, Bastian Engel
, Richard Taubert
, Sara Lorente-Pérez
, Isabel Conde
, Mar Riveiro-Barciela
, Juan-Carlos Ruiz-Cobo
, Carmen Álvarez-Navascués
, Magdalena Salcedo
, Judith Gómez
, Maciej K Janik
, Beatriz Mateos
, Cumali Efe

Alessandro Granito, Elton Datji, Francesco Azzaroli, Diana Horta, Carmen Vila, Inmaculada Castello, Indhira Pérez-Medrano, Ana Arencibia, Alessio Gerussi, Tony Bruns, Francesca Colapierto, Ana Lleo, Natalie Van den Ende, Jef Verbeek, Álvaro Díaz-González, Rosa Ma Morillas, Maria Torner-Simó, Vanesa Bernal, Eva-Maria Fernández, Tom Jg Gevers, Benedetta Terziroli Beretta-Piccoli, Elena Gómez, Paqui Cuenca, Ynte S de Boer, Nanda Kerkar, David N Assis, Rodrigo Liberal, Joost Ph Drenth, Michele M Tana, Marcial Sebode, International Autoimmune Hepatitis Group (IAIHG) collaborators, ERN-Liver, ColHai Registry, Maria-Carlota Londono^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background & Aims: Management of patients with autoimmune hepatitis (AIH)-related decompensated cirrhosis is challenging because of the risk of treatment-related complications and lack of clinical recommendations. We investigated the predictive factors for treatment benefit in AIH-related decompensated cirrhosis at diagnosis and developed an algorithm to guide treatment decisions in clinical practice. Methods: This retrospective, international, multicenter study included 232 patients with histologically confirmed AIH-related decompensated cirrhosis at diagnosis. The sub-hazard ratio (SHR) of mortality was determined by competing risk analysis, considering liver transplantation (LT) as competing event. A decision tree analysis was used to develop a treatment algorithm. Results: At diagnosis, 89% of patients had ascites, and 41% had overt hepatic encephalopathy (OHE). Treated patients (n = 214; 92%) had higher aminotransferases, bilirubin, and modified hepatic activity index. The SHR of mortality was lower in treated patients (0.438; 95% confidence interval [CI], 0.196–0.981; P = .045). Patients without OHE grade 3/4 and Model for End-Stage Liver Disease-Sodium (MELD-Na) ≤28 at diagnosis were more likely to benefit from treatment. In these patients, a decline in MELD-Na ≥11 after 4 weeks of treatment had a 100% negative predictive value for death/LT. Forty-nine percent of treated patients recompensated during follow-up. Twenty percent of patients had to discontinue treatment, 65% during the first 4 weeks, and only 4% due to infectious complications. OHE ≥grade 2 and MELD-Na at diagnosis predicted the need for treatment discontinuation. Conclusions: Immunosuppression is beneficial in patients with AIH-related decompensated cirrhosis and active disease. OHE and MELD-Na at diagnosis, along with a decline in MELD-Na at 4 weeks of treatment, are the most important determinants of outcome and can guide treatment decisions.

Original language	English
Pages (from-to)	1055-1067.e6
Journal	Clinical gastroenterology and hepatology
Volume	24
Issue number	4
Early online date	8 Apr 2025
DOIs	https://doi.org/10.1016/j.cgh.2025.02.010
Publication status	Published - Apr 2026

Keywords

autoimmune hepatitis
decompensated cirrhosis
liver transplant-free survival
recompensation

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10.1016/j.cgh.2025.02.010

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Arvaniti, P., Rodríguez-Tajes, S., Padilla, M., Olivas, I., Mauro, E., Maimouni, C. E., Lytvyak, E., Verhelst, X., Engel, B., Taubert, R., Lorente-Pérez, S., Conde, I., Riveiro-Barciela, M., Ruiz-Cobo, J.-C., Álvarez-Navascués, C., Salcedo, M., Gómez, J., Janik, M. K., Mateos, B., ... Londono, M.-C. (2026). Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis. Clinical gastroenterology and hepatology, 24(4), 1055-1067.e6. https://doi.org/10.1016/j.cgh.2025.02.010

@article{8a46e304a1e64e4e9b806a9ec7703f76,

title = "Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis",

abstract = "Background \& Aims: Management of patients with autoimmune hepatitis (AIH)-related decompensated cirrhosis is challenging because of the risk of treatment-related complications and lack of clinical recommendations. We investigated the predictive factors for treatment benefit in AIH-related decompensated cirrhosis at diagnosis and developed an algorithm to guide treatment decisions in clinical practice. Methods: This retrospective, international, multicenter study included 232 patients with histologically confirmed AIH-related decompensated cirrhosis at diagnosis. The sub-hazard ratio (SHR) of mortality was determined by competing risk analysis, considering liver transplantation (LT) as competing event. A decision tree analysis was used to develop a treatment algorithm. Results: At diagnosis, 89\% of patients had ascites, and 41\% had overt hepatic encephalopathy (OHE). Treated patients (n = 214; 92\%) had higher aminotransferases, bilirubin, and modified hepatic activity index. The SHR of mortality was lower in treated patients (0.438; 95\% confidence interval [CI], 0.196–0.981; P = .045). Patients without OHE grade 3/4 and Model for End-Stage Liver Disease-Sodium (MELD-Na) ≤28 at diagnosis were more likely to benefit from treatment. In these patients, a decline in MELD-Na ≥11 after 4 weeks of treatment had a 100\% negative predictive value for death/LT. Forty-nine percent of treated patients recompensated during follow-up. Twenty percent of patients had to discontinue treatment, 65\% during the first 4 weeks, and only 4\% due to infectious complications. OHE ≥grade 2 and MELD-Na at diagnosis predicted the need for treatment discontinuation. Conclusions: Immunosuppression is beneficial in patients with AIH-related decompensated cirrhosis and active disease. OHE and MELD-Na at diagnosis, along with a decline in MELD-Na at 4 weeks of treatment, are the most important determinants of outcome and can guide treatment decisions.",

keywords = "autoimmune hepatitis, decompensated cirrhosis, liver transplant-free survival, recompensation",

author = "Pinelopi Arvaniti and Sergio Rodr{\'i}guez-Tajes and Marlene Padilla and Ignasi Olivas and Ezequiel Mauro and Maimouni, \{Cautar El\} and Ellina Lytvyak and Xavier Verhelst and Bastian Engel and Richard Taubert and Sara Lorente-P{\'e}rez and Isabel Conde and Mar Riveiro-Barciela and Juan-Carlos Ruiz-Cobo and Carmen {\'A}lvarez-Navascu{\'e}s and Magdalena Salcedo and Judith G{\'o}mez and Janik, \{Maciej K\} and Beatriz Mateos and Cumali Efe and Alessandro Granito and Elton Datji and Francesco Azzaroli and Diana Horta and Carmen Vila and Inmaculada Castello and Indhira P{\'e}rez-Medrano and Ana Arencibia and Alessio Gerussi and Tony Bruns and Francesca Colapierto and Ana Lleo and \{Van den Ende\}, Natalie and Jef Verbeek and {\'A}lvaro D{\'i}az-Gonz{\'a}lez and Morillas, \{Rosa Ma\} and Maria Torner-Sim{\'o} and Vanesa Bernal and Eva-Maria Fern{\'a}ndez and Gevers, \{Tom Jg\} and Beretta-Piccoli, \{Benedetta Terziroli\} and Elena G{\'o}mez and Paqui Cuenca and \{de Boer\}, \{Ynte S\} and Nanda Kerkar and Assis, \{David N\} and Rodrigo Liberal and Drenth, \{Joost Ph\} and Tana, \{Michele M\} and Marcial Sebode and \{International Autoimmune Hepatitis Group (IAIHG) collaborators\} and ERN-Liver and \{ColHai Registry\} and Maria-Carlota Londono",

year = "2026",

month = apr,

doi = "10.1016/j.cgh.2025.02.010",

language = "English",

volume = "24",

pages = "1055--1067.e6",

journal = "Clinical gastroenterology and hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders",

number = "4",

}

Arvaniti, P, Rodríguez-Tajes, S, Padilla, M, Olivas, I, Mauro, E, Maimouni, CE, Lytvyak, E, Verhelst, X, Engel, B, Taubert, R, Lorente-Pérez, S, Conde, I, Riveiro-Barciela, M, Ruiz-Cobo, J-C, Álvarez-Navascués, C, Salcedo, M, Gómez, J, Janik, MK, Mateos, B, Efe, C, Granito, A, Datji, E, Azzaroli, F, Horta, D, Vila, C, Castello, I, Pérez-Medrano, I, Arencibia, A, Gerussi, A, Bruns, T, Colapierto, F, Lleo, A, Van den Ende, N, Verbeek, J, Díaz-González, Á, Morillas, RM, Torner-Simó, M, Bernal, V, Fernández, E-M, Gevers, TJ, Beretta-Piccoli, BT, Gómez, E, Cuenca, P, de Boer, YS, Kerkar, N, Assis, DN, Liberal, R, Drenth, JP, Tana, MM, Sebode, M, International Autoimmune Hepatitis Group (IAIHG) collaborators, ERN-Liver, ColHai Registry & Londono, M-C 2026, 'Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis', Clinical gastroenterology and hepatology, vol. 24, no. 4, pp. 1055-1067.e6. https://doi.org/10.1016/j.cgh.2025.02.010

TY - JOUR

T1 - Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis

AU - Arvaniti, Pinelopi

AU - Rodríguez-Tajes, Sergio

AU - Padilla, Marlene

AU - Olivas, Ignasi

AU - Mauro, Ezequiel

AU - Maimouni, Cautar El

AU - Lytvyak, Ellina

AU - Verhelst, Xavier

AU - Engel, Bastian

AU - Taubert, Richard

AU - Lorente-Pérez, Sara

AU - Conde, Isabel

AU - Riveiro-Barciela, Mar

AU - Ruiz-Cobo, Juan-Carlos

AU - Álvarez-Navascués, Carmen

AU - Salcedo, Magdalena

AU - Gómez, Judith

AU - Janik, Maciej K

AU - Mateos, Beatriz

AU - Efe, Cumali

AU - Granito, Alessandro

AU - Datji, Elton

AU - Azzaroli, Francesco

AU - Horta, Diana

AU - Vila, Carmen

AU - Castello, Inmaculada

AU - Pérez-Medrano, Indhira

AU - Arencibia, Ana

AU - Gerussi, Alessio

AU - Bruns, Tony

AU - Colapierto, Francesca

AU - Lleo, Ana

AU - Van den Ende, Natalie

AU - Verbeek, Jef

AU - Díaz-González, Álvaro

AU - Morillas, Rosa Ma

AU - Torner-Simó, Maria

AU - Bernal, Vanesa

AU - Fernández, Eva-Maria

AU - Gevers, Tom Jg

AU - Beretta-Piccoli, Benedetta Terziroli

AU - Gómez, Elena

AU - Cuenca, Paqui

AU - de Boer, Ynte S

AU - Kerkar, Nanda

AU - Assis, David N

AU - Liberal, Rodrigo

AU - Drenth, Joost Ph

AU - Tana, Michele M

AU - Sebode, Marcial

AU - International Autoimmune Hepatitis Group (IAIHG) collaborators

AU - ERN-Liver

AU - ColHai Registry

AU - Londono, Maria-Carlota

PY - 2026/4

Y1 - 2026/4

N2 - Background & Aims: Management of patients with autoimmune hepatitis (AIH)-related decompensated cirrhosis is challenging because of the risk of treatment-related complications and lack of clinical recommendations. We investigated the predictive factors for treatment benefit in AIH-related decompensated cirrhosis at diagnosis and developed an algorithm to guide treatment decisions in clinical practice. Methods: This retrospective, international, multicenter study included 232 patients with histologically confirmed AIH-related decompensated cirrhosis at diagnosis. The sub-hazard ratio (SHR) of mortality was determined by competing risk analysis, considering liver transplantation (LT) as competing event. A decision tree analysis was used to develop a treatment algorithm. Results: At diagnosis, 89% of patients had ascites, and 41% had overt hepatic encephalopathy (OHE). Treated patients (n = 214; 92%) had higher aminotransferases, bilirubin, and modified hepatic activity index. The SHR of mortality was lower in treated patients (0.438; 95% confidence interval [CI], 0.196–0.981; P = .045). Patients without OHE grade 3/4 and Model for End-Stage Liver Disease-Sodium (MELD-Na) ≤28 at diagnosis were more likely to benefit from treatment. In these patients, a decline in MELD-Na ≥11 after 4 weeks of treatment had a 100% negative predictive value for death/LT. Forty-nine percent of treated patients recompensated during follow-up. Twenty percent of patients had to discontinue treatment, 65% during the first 4 weeks, and only 4% due to infectious complications. OHE ≥grade 2 and MELD-Na at diagnosis predicted the need for treatment discontinuation. Conclusions: Immunosuppression is beneficial in patients with AIH-related decompensated cirrhosis and active disease. OHE and MELD-Na at diagnosis, along with a decline in MELD-Na at 4 weeks of treatment, are the most important determinants of outcome and can guide treatment decisions.

AB - Background & Aims: Management of patients with autoimmune hepatitis (AIH)-related decompensated cirrhosis is challenging because of the risk of treatment-related complications and lack of clinical recommendations. We investigated the predictive factors for treatment benefit in AIH-related decompensated cirrhosis at diagnosis and developed an algorithm to guide treatment decisions in clinical practice. Methods: This retrospective, international, multicenter study included 232 patients with histologically confirmed AIH-related decompensated cirrhosis at diagnosis. The sub-hazard ratio (SHR) of mortality was determined by competing risk analysis, considering liver transplantation (LT) as competing event. A decision tree analysis was used to develop a treatment algorithm. Results: At diagnosis, 89% of patients had ascites, and 41% had overt hepatic encephalopathy (OHE). Treated patients (n = 214; 92%) had higher aminotransferases, bilirubin, and modified hepatic activity index. The SHR of mortality was lower in treated patients (0.438; 95% confidence interval [CI], 0.196–0.981; P = .045). Patients without OHE grade 3/4 and Model for End-Stage Liver Disease-Sodium (MELD-Na) ≤28 at diagnosis were more likely to benefit from treatment. In these patients, a decline in MELD-Na ≥11 after 4 weeks of treatment had a 100% negative predictive value for death/LT. Forty-nine percent of treated patients recompensated during follow-up. Twenty percent of patients had to discontinue treatment, 65% during the first 4 weeks, and only 4% due to infectious complications. OHE ≥grade 2 and MELD-Na at diagnosis predicted the need for treatment discontinuation. Conclusions: Immunosuppression is beneficial in patients with AIH-related decompensated cirrhosis and active disease. OHE and MELD-Na at diagnosis, along with a decline in MELD-Na at 4 weeks of treatment, are the most important determinants of outcome and can guide treatment decisions.

KW - autoimmune hepatitis

KW - decompensated cirrhosis

KW - liver transplant-free survival

KW - recompensation

U2 - 10.1016/j.cgh.2025.02.010

DO - 10.1016/j.cgh.2025.02.010

M3 - Article

SN - 1542-3565

VL - 24

SP - 1055-1067.e6

JO - Clinical gastroenterology and hepatology

JF - Clinical gastroenterology and hepatology

IS - 4

ER -

Hepatic encephalopathy and MELD-Na predict treatment benefit in autoimmune hepatitis-related decompensated cirrhosis

Abstract

Keywords

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