This protocol targets patients with acute severe autoimmune hepatitis presenting with jaundice and an INR between 1.5 and 2, with no hepatic encephalopathy and no previously recognised liver disease.
It applies specifically when the initial steroid-based treatment trial has failed to achieve the expected improvement in liver function and inflammation markers.
The first-line approach for acute severe AIH is a treatment trial with prednisone or prednisolone alone. The required outcome is improvement in liver inflammation markers — specifically serum aminotransferases and bilirubin — without clinical deterioration, assessed at 1–2 weeks.
When laboratory tests do not improve, or the patient clinically worsens within that window, escalation to this next protocol step is indicated.
Patients who do not respond to initial glucocorticoid therapy within the assessment period are candidates for evaluation for a definitive surgical intervention. The complete structured protocol specifies the criteria, timing, and pathway for this escalation.
DOI: 10.1002/hep.31065
Acute severe AIH Jaundice, INR > 1.5 < 2, no encephalopathy; no previously recognized liver disease.
Patients with acute severe AIH should receive a treatment trial with prednisone or prednisolone alone, whereas patients with AIH and ALF should be evaluated directly for LT.
Patients with acute severe AIH should receive predniso(lo)ne followed by LT if no improvement within 2 weeks, whereas patients with AIH and ALF should be evaluated directly for LT.
Patients with acute severe AIH who do not improve laboratory tests or clinically worsen within 1-2 weeks of glucocorticoid therapy should be evaluated for LT.
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