Features and Progression of Asymptomatic Autoimmune Hepatitis in Italy

BACKGROUND & AIMS: Patients with autoimmune hepatitis (AIH) can present with symptoms ranging from those that are insidious and nonspecific to acute hepatitis with jaundice. However, some patients have no symptoms at diagnosis and are identified incidentally. We investigated disease progression and outcomes of these 2 groups of patients. METHODS: We performed a retrospective study to compare clinical, immunologic, and histologic features and outcomes of patients with asymptomatic vs symptomatic AIH. We analyzed data collected from 305 patients (90 asymptomatic and 215 with symptoms), diagnosed with AIH from 1994 and 2013, at the Center for the Study and Treatment of the Autoimmune Diseases of the Liver and Biliary System in Bologna, Italy. RESULTS: At diagnosis, patients with asymptomatic AIH had significantly lower mean levels of alanine aminotransferase (7.0 +/- 8.0-fold the upper limit of normal) than patients with symptomatic disease (23.0 +/- 18.0-fold the upper limit of normal; P < .001), and lower mean levels of bilirubin (1.4 +/- 1.4 mg/dL vs 8.6 +/- 10.4 mg/dL; P < .001). Asymptomatic patients also had significantly lower histologic grades (7.0 +/- 2.5) than symptomatic patients (9.0 +/- 2.9; P < .001). However, larger proportions of asymptomatic patients had anti-liver/kidney microsomal antibodies type 1 (26.8% vs 13.1%; P < .006), and associated autoimmune thyroid (26.7% vs 12.6%; P = .003) or skin (8.9% vs 2.3%; P = .010) disorders. Age at onset, sex, response to therapy, disease progression, genetic factors, and other autoantibody markers did not differ between patients with asymptomatic vs symptomatic disease. CONCLUSIONS: Patients with asymptomatic vs symptomatic AIH have similar courses of disease progression and responses to immunosuppressive agents, and therefore should receive the same treatment. Patients affected by thyroid or dermatologic autoimmune disorders are at increased risk of developing subclinical liver disease, and should be assessed routinely for AIH.