{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T11:44:20Z","timestamp":1750765460141,"version":"3.40.5"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T00:00:00Z","timestamp":1641340800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Treatment of patients with severe indeterminate hepatitis (IAH) is an unmet need. Corticosteroids are often used in the management of these patients but criteria for the selection of patients for this intervention are arbitrary. The aims of this study were to analyse the clinical and pathological features of patients with IAH to define predictors of corticosteroid responsiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study included consecutive patients with acute indeterminate hepatitis admitted to a single hospital and underwent a liver biopsy. The clinical manifestation and histopathological features of steroid and non\u2010steroid groups were compared and their relationship with corticosteroids response was evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010eight patients were included, 24 (50%) recovered and the other half underwent liver transplantation or died within 3\u2010months. Of the 48 cases, 24 received corticosteroids (initial dose of 45\u00a0\u00b1\u00a012\u00a0mg prednisolone). Corticosteroids were initiated 2.7\u00a0\u00b1\u00a03.8\u00a0days after admission. Liver biopsy was performed 2\u2010days (median, IQR 1\u20103) after admission. Fifteen (62.5%) patients receiving corticosteroids survived without transplantation compared with 9 (37.5%) that did not receive steroids (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.149). In those with multilobular necrosis, 50% reduction in the death\/transplantation rate was observed after steroid treatment (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.018). In patients without multilobular necrosis and with or without perivenulitis, corticosteroids did not impact the outcome. Response to corticosteroids was independent of the MELD score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The presence of multilobular necrosis on liver biopsy helps identify a subgroup of IAH cases who may benefit from the administration of corticosteroids.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15144","type":"journal-article","created":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T14:28:16Z","timestamp":1640183296000},"page":"853-863","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Presence of multilobular necrosis on liver biopsy identifies corticosteroid responsiveness in acute indeterminate hepatitis"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7517-9859","authenticated-orcid":false,"given":"Su","family":"Lin","sequence":"first","affiliation":[{"name":"Liver failure Group Institute for Liver and Digestive Health Division of Medicine University College London Medical School Royal Free Hospital  London UK"},{"name":"Department of Hepatology, Hepatology Research Institute, the First Affiliated Hospital Fujian Medical University  Fuzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catarina","family":"Araujo","sequence":"additional","affiliation":[{"name":"Department of Cellular Pathology Royal Free Hospital  London UK"},{"name":"Anatomical\u2010Pathology Department Centro Hospitalar Universit\u00e1rio Lisboa Central  Lisboa Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Hall","sequence":"additional","affiliation":[{"name":"Liver failure Group Institute for Liver and Digestive Health Division of Medicine University College London Medical School Royal Free Hospital  London UK"},{"name":"Department of Cellular Pathology Royal Free Hospital  London UK"},{"name":"Sheila Sherlock Liver Center Royal Free London NHS Foundation Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5092-4821","authenticated-orcid":false,"given":"Rahul","family":"Kumar","sequence":"additional","affiliation":[{"name":"Liver failure Group Institute for Liver and Digestive Health Division of Medicine University College London Medical School Royal Free Hospital  London UK"},{"name":"Department of Gastroenterology and Hepatology Duke\u2010NUS academic Medical Centre Changi General Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Phillips","sequence":"additional","affiliation":[{"name":"Liver failure Group Institute for Liver and Digestive Health Division of Medicine University College London Medical School Royal Free Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohsin","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Gastroenterology Charit\u00e9\u2014Universitaetsmedizin Berlin  Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelius","family":"Engelmann","sequence":"additional","affiliation":[{"name":"Liver failure Group Institute for Liver and Digestive Health Division of Medicine University College London Medical School Royal Free Hospital  London UK"},{"name":"Department of Hepatology and Gastroenterology Charit\u00e9\u2014Universitaetsmedizin Berlin  Berlin Germany"},{"name":"Section Hepatology Clinic for Gastroenterology and Rheumatology University Hospital Leipzig  Leipzig Germany"},{"name":"Berlin Institute of Health (BIH)  Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Quaglia","sequence":"additional","affiliation":[{"name":"Department of Cellular Pathology and UCL cancer Institute Royal Free Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajiv","family":"Jalan","sequence":"additional","affiliation":[{"name":"Liver failure Group Institute for Liver and Digestive Health Division of Medicine University College London Medical School Royal Free Hospital  London UK"},{"name":"European Foundation for the Study of Chronic Liver Failure (EFCLIF)  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,1,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.14566"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41395-018-0160-2"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2018.12.042"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(17)30997-2"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26678"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2021.08.008"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.2003.50016"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0801209"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0188151"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8278(95)80226-6"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAP.0000000000000112"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.24080"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20130"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.12906"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000000593"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0000000000000353"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.06.030"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.15144","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/liv.15144","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.15144","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,27]],"date-time":"2023-08-27T12:56:27Z","timestamp":1693140987000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.15144"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,5]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1111\/liv.15144"],"URL":"https:\/\/doi.org\/10.1111\/liv.15144","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"type":"print","value":"1478-3223"},{"type":"electronic","value":"1478-3231"}],"subject":[],"published":{"date-parts":[[2022,1,5]]},"assertion":[{"value":"2021-09-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}