Clinical presentation, response to therapy, and predictors of fibrosis in patients with autoimmune hepatitis in Saudi Arabia.

BACKGROUND Autoimmune hepatitis (AIH) is a relapsing inflammatory disease of the liver of unknown cause. Little is known about AIH in Saudi Arabia. OBJECTIVES Our aim is to 1) identify the special clinical or histological features in our patients, 2) describe the initial response to immunosuppressive therapy and long term relapse, 3) identify clinical and laboratory predictors of response to therapy, and 4) examine the utility of laboratory markers (platelet count, AST/ALT ratio, and the AST to platelet ratio index (APRI score) in predicting the presence of advanced fibrosis. METHODS Patients were identified using a computer database. Patients responding to initial therapy were compared with patients who did not respond in terms of laboratory and histology parameters. The utility of three fibrosis markers/models were then examined. RESULTS Thirty-nine patients with AIH were included in this analysis. The mean age was 45.4; 65% of patients were females. Mean ALT at presentation was 268 U/L and AST was 277 U/ L. GGT level was found to be the only statistically significant laboratory or histopathological parameter difference between responders and non-responders. Platelet count and AST/ALT ratio were found to be the best predictors of advanced fibrosis. CONCLUSION In Saudi patients with AIH, we found that the GGT level at presentation may serve as a useful predictor for response to therapy. Platelet count and AST/ALT ratio may be used to predict advanced fibrosis.