Increasing incidence of acute autoimmune hepatitis: a nationwide survey in Japan

Atsushi Takahashi,Kaname Yoshizawa,Hajime Takikawa,Kazumichi Abe,Mikio Zeniya,Jong-Hon Kang,Takuji Torimura,Atsushi Tanaka,Masanori Abe,Yoshiyuki Suzuki,Akinobu Takaki,Ayano Inui,Hiromasa Ohira,Teruko Arinaga-Hino,Nobuhiro Nakamoto

doi:10.1038/s41598-020-71296-0

Abstract

The Japanese diagnostic guidelines for autoimmune hepatitis (AIH) were proposed in 2014. This study aimed to determine the trends and characteristics of AIH based on a Japanese nationwide survey. Data for 796 patients who were newly diagnosed with AIH from 2014 to 2017 were collected from January to March, 2019 from 54 hospitals throughout Japan. Clinical characteristics, including treatment, were compared with those reported in a prior 2015 survey. The population had a median age of 63 years at diagnosis, and the male to female ratio was 1:5.3. The numbers of women was significantly lower in this survey than in the 2015 survey. Moreover, the incidence of AIH with histological acute hepatitis increased significantly from 11.0 to 21.7%. The changes in the laboratory findings, such as in transaminase and immunoglobulin G levels and antinuclear antibody titers, as well as in prednisolone treatment, reflected an increasing incidence of acute AIH. The clinical characteristics of AIH changed rapidly, in parallel with the increasing incidence of acute AIH. The elucidation and diagnosis of AIH with acute hepatitis are important in the management of AIH.

Highlights

Atsushi Takahashi1*, Hiromasa Ohira1, Kazumichi Abe1, Mikio Zeniya2, Masanori Abe3, Teruko Arinaga‐Hino4, Takuji Torimura4, Kaname Yoshizawa5, Akinobu Takaki6, Jong‐Hon Kang7, Yoshiyuki Suzuki8, Nobuhiro Nakamoto9, Ayano Inui10, Atsushi Tanaka11 & Hajime Takikawa12
Autoimmune hepatitis (AIH) with an acute presentation is difficult to diagnose based on a scoring system because of low immunoglobulin G (IgG) levels and antinuclear antibody (ANA) titers, its clinical and histological characteristics have been gradually elucidated by several r eports1–18
The Japanese nationwide survey in 2009 was the first to report that 95 of 871 (10.9%) patients with autoimmune hepatitis (AIH) had acute h epatitis1; this frequency remained steady at 11.7% in the 2015 s urvey2, but it increased significantly to 21.7% in the 2018 survey

Summary

Introduction

Atsushi Takahashi1*, Hiromasa Ohira, Kazumichi Abe, Mikio Zeniya, Masanori Abe, Teruko Arinaga‐Hino, Takuji Torimura, Kaname Yoshizawa, Akinobu Takaki, Jong‐Hon Kang, Yoshiyuki Suzuki, Nobuhiro Nakamoto, Ayano Inui, Atsushi Tanaka11 & Hajime Takikawa. This study aimed to determine the trends and characteristics of AIH based on a Japanese nationwide survey. The incidence of AIH with histological acute hepatitis increased significantly from 11.0 to 21.7%. The changes in the laboratory findings, such as in transaminase and immunoglobulin G levels and antinuclear antibody titers, as well as in prednisolone treatment, reflected an increasing incidence of acute AIH. Autoimmune hepatitis (AIH) with an acute presentation is difficult to diagnose based on a scoring system because of low immunoglobulin G (IgG) levels and antinuclear antibody (ANA) titers, its clinical and histological characteristics have been gradually elucidated by several r eports. The aim of this study was to elucidate the recent trends in AIH in Japan by comparing the results of the 2015 survey to a 2018 survey

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Conclusion