Biochemical remission in autoimmune hepatitis determines health-realted quality of life

Background and aims Autoimmune hepatitis (AIH) is a rare chronic liver disease resulting from inflammation and eventual destruction of hepatocytes. The health-related quality of life (HRQL) is often impaired. In this prospective study we determined the impact of biochemical remission on HRQL using the validated chronic liver disease questionnaire (CLDQ) in AIH.

Methods A total of 116 patients with AIH were prospectively enrolled in this study at an outpatient hepatology clinic in Germany starting in July 2018. The CLDQ was used to assess HRQL and clinical and laboratory assessment was performed at baseline.

Results The mean CLDQ overall score was 5.3 ± 1.3 with the lowest score in the subscale fatigue (4.3 ± 1.7) and the highest score for activity (5.8 ± 1.3). The score for activity was significantly lower in female than in male (5.7 ± 1.4 vs. 6.4 ± 0.9; p  <  0.05). Patients with a complete biochemical remission to immunosuppressive therapy defined as normalization of ALT, AST and IgG had a significantly higher CLDQ overall score compared to patients with incomplete remission (5.7 ± 1.2 vs. 5.1 ± 1.3; p  <  0.05). The scores of the subscales abdominal symptoms (6.1 ± 1.4; p  <  0.05), activity (6.2 ± 1.2; p  <  0.05), emotional functioning (5.44 ± 1.40; p  <  0.05) and worry (5.8 ± 1.5; p  <  0.05) were also significantly higher in patients with complete remission. Interestingly, the subscale fatigue, which showed the lowest score overall, was independent of biochemical remission (4.7 ± 1.6 vs. 4.1 ± 1.7; p = 0.104). There was a negative correlation between the level of gGT and the CLDQ total value (r = -0.276; p  <  0.01). A negative correlation was also observed for other cholestatic parameters including bilirubin and ALP with the subscales fatigue (bilirubin: r = -0.218; p  <  0.05), systemic symptoms (ALP: r = -0.241; p  <  0.05) and activity (ALP: r = -0.222, p  <  0.05).

Conclusions Overall, AIH is associated with a high symptom burden. Complete biochemical remission to treatment is associated with a significant higher HRQL. In addition, cholestatic parameters showed significantly higher scores for several subscales of the CLDQ.

Publication History

Article published online:
08 September 2020