medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2017, Number 5

<< Back Next >>

Ann Hepatol 2017; 16 (5)

Validation of the Simplified Criteria for the Diagnosis of Autoimmune Hepatitis in Chilean-Hispanic Patients

Candia R, Norero B, Agüero C, Díaz L, Ortega JP, Wolff R, Hernández-Rocha C, Duarte I, Soza A, Benítez C, Arrese M

Language: English
References: 45
Page: 772-779
PDF size: 210.60 Kb.


ABSTRACT

Introduction and aim. In 2008 the International autoimmune hepatitis (AIH) Group proposed the simplified diagnostic criteria for this disease. The original cohort study was performed in 11 international centers, but validation studies are scarce in Latin-America. The aim of this study is validate these criteria in Hispanic patients. Material and methods. A retrospective cohort of patients undergoing percutaneous liver biopsy and follow-up of at least 12 months was recruited from a Chilean University hospital. Patients with previous immunosuppressive therapy and liver transplant recipients were excluded. The diagnostic accuracy was analyzed using as gold standard the clinical course during long-term follow-up. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) and area under the ROC curve (AUROC) were calculated. Results. Four hundred eighty one patients were evaluated, 294 were included. 218 (74.15%) were female, mean age 48.5 (± 12.3) years, mean follow-up 34 (± 18) months. 66 patients had AIH or overlap syndrome (22.45%), 96 (32.65%) non-alcoholic steatohepatitis, 40 (13.61%) primary biliary cholangitis, 31 (10.54%) hepatitis C, 8 (2.72%) hepatitis B, 53 (18.02%) other etiologies. The AUROC for AIH simplified criteria was 0.976. Using a cutoff ≥ 6 and ≥ 7 points, the sensitivity was 86.4% and 54.6%; specificity, 98.7% and 99.6%; PPV, 95% and 97.3%; and NPV, 96.2% and 88.6%, respectively. Conclusion. Simplified criteria for the diagnosis of AIH have a high accuracy in our Chilean-Hispanic cohort. The female gender is strongly associated to AIH and could help in difficult cases. Further studies with a prospective design are necessary to confirm these observations.


REFERENCES

  1. Manns MP, Czaja AJ, Gorham JD, Krawitt EL, Mieli-Vergani G, Vergani D, Vierling JM, American Association for the Study of Liver Diseases. Diagnosis and management of autoimmune hepatitis. Hepatology 2010; 51: 2193-213.

  2. Czaja AJ. Autoimmune liver disease. Current Opinion in Gastroenterology 2008; 24: 298-305.

  3. Montano Loza AJ, Czaja AJ. Current therapy for autoimmune hepatitis. Nature Clinical Practice Gastroenterology & Hepatology 2007; 4: 202-14.

  4. Cattan P, Berney T, Conti F, Calmus Y, Homberg JC, Houssin D, Soubrane O. Outcome of orthotopic liver transplantation in autoimmune hepatitis according to subtypes. Transplant International 2002; 15: 34-8.

  5. Ayata G, Gordon FD, Lewis WD, Pomfret E, Pomposelli JJ, Jenkins RL, Khettry U. Liver transplantation for autoimmune hepatitis: a long-term pathologic study. Hepatology 2000; 32: 185-92.

  6. Ayata G, Gordon FD, Lewis WD, Pomfret E, Pomposelli JJ, Jenkins RL, Khettry U. Cryptogenic cirrhosis: clinicopathologic findings at and after liver transplantation. Human Pathology 2002; 33: 1098-104.

  7. Kim BH, Kim YJ, Jeong SH, Tak WY, Ahn SH, Lee YJ, Jung EU, et al. Clinical features of autoimmune hepatitis and comparison of two diagnostic criteria in Korea: a nationwide, multicenter study. J Gastroenterol & Hepatol 2013; 28: 128-34.

  8. Boberg KM, Aadland E, Jahnsen J, Raknerud N, Stiris M, Bell H. Incidence and prevalence of primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis in a Norwegian population. Scandinavian J Gastroenterol 1998; 33: 99-103.

  9. Werner M, Prytz H, Ohlsson B, Almer S, Bjornsson E, Bergquist A, Wallerstedt S, et al. Epidemiology and the initial presentation of autoimmune hepatitis in Sweden: a nationwide study. Scandinavian J Gastroenterol 2008; 43: 1232-40.

  10. Ngu JH, Bechly K, Chapman BA, Burt MJ, Barclay ML, Gearry RB, Stedman CA. Population-based epidemiology study of autoimmune hepatitis: a disease of older women? J Gastroenterol Hepatol 2010; 25: 1681-6.

  11. Lee YM, Teo EK, Ng TM, Khor C, Fock KM. Autoimmune hepatitis in Singapore: a rare syndrome affecting middle-aged women. J Gastroenterol & Hepatol 2001; 16: 1384-9.

  12. Jalihal A, Telisinghe PU, Chong VH. Profiles of autoimmune hepatitis in Brunei Darussalam. Hepatobiliary & Pancreatic Diseases International 2009; 8: 602-7.

  13. Wong RJ, Gish R, Frederick T, Bzowej N, Frenette C. The impact of race/ethnicity on the clinical epidemiology of autoimmune hepatitis. J Clin Gastroenterol 2012; 46: 155-61.

  14. Czaja AJ. Autoimmune hepatitis in diverse ethnic populations and geographical regions. Expert Rev Gastroenterol & Hepatol 2013; 7: 365-85.

  15. Johnson PJ, McFarlane IG. Meeting report: International Autoimmune Hepatitis Group. Hepatology 1993; 18: 998-1005.

  16. Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, Chapman RW, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999; 31: 929-38.

  17. Toda G, Zeniya M, Watanabe F, Imawari M, Kiyosawa K, Nishioka M, Tsuji T, et al. Present status of autoimmune hepatitis in Japan--correlating the characteristics with international criteria in an area with a high rate of HCV infection. Japanese National Study Group of Autoimmune Hepatitis. J Hepatol 1997; 26: 1207-12.

  18. Czaja A, Carpenter HA. Validation of scoring system for diagnosis of autoimmune hepatitis. Dig Dis Sci 1996; 41: 305-14.

  19. Bianchi FB, Cassani F, Lenzi M, Ballardini G, Muratori L, Giostra F, Zauli D. Impact of international autoimmune hepatitis group scoring system in definition of autoimmune hepatitis. An Italian experience. Dig Dis Sci 1996; 41: 166-71.

  20. Dickson RC, Gaffey MJ, Ishitani MB, Roarty TP, Driscoll CJ, Caldwell SH. The international autoimmune hepatitis score in chronic hepatitis C. J Viral Hepat 1997; 4: 121-8.

  21. Hennes EM, Zeniya M, Czaja AJ, Pares A, Dalekos GN, Krawitt EL, Bittencourt PL, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology 2008; 48: 169-76.

  22. Czaja AJ. Performance parameters of the diagnostic scoring systems for autoimmune hepatitis. Hepatology 2008; 48: 1540-8.

  23. Muratori P, Granito A, Pappas G, Muratori L. Validation of simplified diagnostic criteria for autoimmune hepatitis in Italian patients. Hepatology 2009; 49: 1782-3.

  24. Miyake Y, Iwasaki Y, Kobashi H, Yasunaka T, Ikeda F, Takaki A, Yamamoto K. Clinical features of autoimmune hepatitis diagnosed based on simplified criteria of the International Autoimmune Hepatitis Group. Digestive & Liver Disease 2010; 42: 210-5.

  25. Qiu D, Wang Q, Wang H, Xie Q, Zang G, Jiang H, Tu C, et al. Validation of the simplified criteria for diagnosis of autoimmune hepatitis in Chinese patients. J Hepatol 2011; 54: 340-7.

  26. Yeoman AD, Westbrook RH, Al-Chalabi T, Carey I, Heaton ND, Portmann BC, Heneghan MA. Diagnostic value and utility of the simplified International Autoimmune Hepatitis Group (IAIHG) criteria in acute and chronic liver disease. Hepatology 2009; 50: 538-45.

  27. Fujiwara K, Yasui S, Tawada A, Fukuda Y, Nakano M, Yokosuka O. Diagnostic value and utility of the simplified International Autoimmune Hepatitis Group criteria in acute-onset autoimmune hepatitis. Liver International 2011; 31: 1013-20.

  28. Gatselis NK, Zachou K, Papamichalis P, Koukoulis GK, Gabeta S, Dalekos GN, Rigopoulou EI. Comparison of simplified score with the revised original score for the diagnosis of autoimmune hepatitis: a new or a complementary diagnostic score? Dig Liver Dis 2010; 42: 807-12.

  29. Londoño MC, Gonzalez L, Chavarriaga J, Múnera V, Ramos F, Suárez L, Marin JI, et al. Aplicación del modelo diagnóstico del grupo internacional para la hepatitis autoinmune (GIHA) en una población de pacientes de Medellín, Colombia. Rev Colomb Gastroenterol 2003; 18: 16-9.

  30. Menghini G. One-second biopsy of the liver--problems of its clinical application. N Engl J Med 1970; 283: 582-5.

  31. Menghini G. One-second needle biopsy of the liver. Gastroenterology 1958; 35: 190-9.

  32. PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990; 263: 2753-9.

  33. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155: 529-36.

  34. American Gastroenterological Association medical position statement: nonalcoholic fatty liver disease. Gastroenterology 2002; 123: 1702-4.

  35. Strader DB, Wright T, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C. Hepatology 2004; 39: 1147-171.

  36. Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology 2007; 45: 507-39.

  37. Heathcote EJ. Management of primary biliary cirrhosis. The American Association for the Study of Liver Diseases practice guidelines. Hepatology 2000; 31: 1005-13.

  38. Czaja AJ. Frequency and nature of the variant syndromes of autoimmune liver disease. Hepatology 1998; 28: 360-5.

  39. Acuna M, Jorquera H, Cifuentes L, Armanet L. Frequency of the hypervariable DNA loci D18S849, D3S1744, D12S1090 and D1S80 in a mixed ancestry population of Chilean blood donors. Genet Mol Res 2002; 1: 139-46.

  40. Fuentes M, Pulgar I, Gallo C, Bortolini MC, Canizales-Quinteros S, Bedoya G, Gonzalez-Jose R, et al. Gene geography of Chile: Regional distribution of American, European and African genetic contributions. Rev Med Chil 2014; 142: 281-9.

  41. Avena S, Via M, Ziv E, Perez-Stable EJ, Gignoux CR, Dejean C, Huntsman S, et al. Heterogeneity in genetic admixture across different regions of Argentina. PLoS One 2012; 7: e34695.

  42. Corach D, Lao O, Bobillo C, van Der GK, Zuniga S, Vermeulen M, van DK, et al. Inferring continental ancestry of argentineans from Autosomal, Y-chromosomal and mitochondrial DNA. Ann Hum Genet 2010; 74: 65-76.

  43. Wang S, Ray N, Rojas W, Parra MV, Bedoya G, Gallo C, Poletti G, et al. Geographic patterns of genome admixture in Latin American Mestizos. PLoS Genet 2008; 4: e1000037.

  44. Silva-Zolezzi I, Hidalgo-Miranda A, Estrada-Gil J, Fernandez- Lopez JC, Uribe-Figueroa L, Contreras A, Balam-Ortiz E, et al. Analysis of genomic diversity in Mexican Mestizo populations to develop genomic medicine in Mexico. Proc Natl Acad Sci U S A 2009; 106: 8611-6.

  45. Saloum de Neves MF, Pereira R, Vianna R, Rodolfo Beuttenmuller de AA, Leite Goes GD, Aparecida da SD, de Vargas WE, et al. Revisiting the genetic ancestry of Brazilians using autosomal AIM-Indels. PLoS One 2013; 8: e75145.




2020     |     www.medigraphic.com