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CN 22-1108/R
Volume 41 Issue 9
Sep.  2025
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Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(9): 1808-1817

Clinical features of recompensation in autoimmune hepatitis-related decompensated cirrhosis and related predictive factors

DOI: 10.12449/JCH250916
  • 1.

    PLA Medical School，Beijing 100853，China

  • 2.

    Department of Hepatology，The Fifth Medical Center of PLA General Hospital，Beijing 100039，China

  • 3.

    Department of Gastroenterology，Hospital of The PLA 82nd Group Army，Baoding，Hebei 071000，China

Research funding:

National Natural Science Foundation of China (82170538)

More Information
  • Corresponding author: GU Caizhe， doctorgucaizhe@163.com （ORCID： 0009-0005-6755-9567）; SUN Ying， sunying_302@163.com （ORCID： 0000-0002-2570-9206）
  • Received Date: 2025-02-16
  • Accepted Date: 2025-03-27
  • Published Date: 2025-09-25
    Abstract
  •   Objective  To investigate the clinical features and outcomes of recompensation in patients with autoimmune hepatitis （AIH）-related decompensated cirrhosis， to identify independent predictive factors， and to construct a nomogram prediction model for the probability of recompensation.  Methods  A retrospective cohort study was conducted among the adult patients with AIH-related decompensated cirrhosis who were admitted to The Fifth Medical Center of PLA General Hospital from January 2015 to August 2023 （n=211）. The primary endpoint was achievement of recompensation， and the secondary endpoint was liver-related death or liver transplantation. According to the outcome of the patients at the end of the follow-up， the patients were divided into the recompensation group （n=16） and the persistent decompensation group（n=150）.The independent-samples t test was used for comparison of normally distributed continuous data with homogeneity of variance， and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data with heterogeneity of variance； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups； the Kaplan-Meier method was used for survival analysis； the Cox proportional-hazards regression model was used to identify independent predictive factors， and a nomogram model was constructed and validated.  Results  A total of 211 patients were enrolled， with a median age of 55.0 years and a median follow-up time of 44.0 months， and female patients accounted for 87.2%. Among the 211 patients， 61 （with a cumulative proportion of 35.5%） achieved recompensation. Compared with the persistent decompensation group， the recompensation group had significantly higher white blood cell count， platelet count （PLT）， total bilirubin （TBil）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total bile acid， prothrombin time， international normalized ratio （INR）， SMA positive rate， Model for End-Stage Liver Disease （MELD） score， Child-Pugh score， and rate of use of glucocorticoids （all P<0.05）， as well as significantly lower age at baseline， number of complications， and death/liver transplantation rate （all P<0.05）. At 3 and 12 months after treatment， the recompensation group had continuous improvements in AST， TBil， INR， IgG， MELD score， and Child-Pugh score， which were significantly lower than the values in the persistent decompensation group （all P<0.05）， alongside with continuous increases in PLT and albumin， which were significantly higher than the values in the persistent decompensation group （P<0.05）. The multivariate Cox regression analysis showed that baseline ALT （hazard ratio ［HR］=1.067， 95% confidence interval ［CI］： 1.010 — 1.127， P=0.021）， IgG （HR=0.463，95%CI：0.258 — 0.833， P=0.010）， SMA positivity （HR=3.122，95%CI：1.768 — 5.515， P<0.001）， and glucocorticoid therapy （HR=20.651，95%CI：8.744 — 48.770， P<0.001） were independent predictive factors for recompensation， and the nomogram model based on these predictive factors showed excellent predictive performance （C-index=0.87，95%CI：0.84 — 0.90）.  Conclusion  Achieving recompensation significantly improves clinical outcomes in patients with AIH-related decompensated cirrhosis. Baseline SMA positivity， a high level of ALT， a low level of IgG， and corticosteroid therapy are independent predictive factors for recompensation. The predictive model constructed based on these factors can provide a basis for decision-making in individualized clinical management.

     

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