İlyas Ethem ŞENOCAK, Yunus GÜNEGÜL, Yunus Emre DEMİRAL, Talha ERCAN, Ahmet Tarık EMİNLER
Turkish Journal of Gastroenterology - 2026;37(8):900-908
Background/Aims: Autoimmune hepatitis (AIH) is associated with a high rate of relapse following treatment withdrawal. Identifying noninvasive markers that predict disease recurrence is crucial for long-term management. This study evaluated the prognostic performance of the Fibrosis-4 (FIB-4) Index and the Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) in predicting post-treatment relapse in AIH. Materials and Methods: This retrospective, single-center cohort study included 65 patients with AIH between January 2010 and October 2025 who achieved sustained normalization of transaminase under corticosteroid-based therapy and were followed up for at least 12 months. Baseline demographic, laboratory, and noninvasive fibrosis parameters were analyzed. Relapse was defined as alanine aminotransferase or aspartate aminotransferase elevation >=2 times the upper limit of normal and/or serum immunoglobulin G (IgG) above the upper limit, occurring after complete discontinuation of immunosuppressive therapy. Receiver operating characteristic (ROC) curve analysis and logistic regression were performed. Results: Relapse occurred in 26 patients (40.0%). Patients with relapse had higher baseline serum IgG (P < .001), lower platelet counts (P = .004), and higher APRI and FIB-4 scores (P < .001 for both). ROC analysis identified optimal cutoff values of APRI > 1.54 (area under the curve (AUC) = 0.81) and FIB-4 > 3.84 (AUC = 0.80). In multivariate analysis, baseline IgG (odds ratio (OR) = 1.09; 95% CI = 1.00-1.18; P = .049) and FIB-4 > 3.84 (OR = 6.68; 95% CI = 2.02-22.10; P = .002) remained independent predictors. Conclusion: Baseline FIB-4 and serum IgG independently predict relapse following discontinuation of immunosuppressive therapy in AIH and may support individualized follow-up strategies.
