Fibrosis-4 and Aspartate Aminotransferase-to-Platelet Ratio Index as Predictors of Relapse in Autoimmune Hepatitis: A Retrospective Single-Center Study

Abstract

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.

Cite this article as: Şenocak İE, Günegül Y, Demiral YE, Ercan T, Eminler AT. Fibrosis-4 and Aspartate Aminotransferase-to-Platelet Ratio Index as predictors of relapse in autoimmune hepatitis: A retrospective single center study. Turk J Gastroenterol. Published online June 25, 10.5152/tjg.2026.26177.