Development and progression of hepatic steatosis during long-term glucocorticoid therapy in autoimmune hepatitis: multimodal evidence from biopsy, CAP, and ultrasound.

INTRODUCTION: Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease treated with glucocorticoids (GCs). Long-term GCs therapy may increase the risk of hepatic steatosis. This study aimed to evaluate the impact of prolonged GCs therapy on hepatic steatosis in patients with AIH. METHODS: We retrospectively analyzed patients with AIH treated at a single center from January 2017 to December 2023. Eligible patients had received systemic GCs therapy for at least 24 months and had at least one paired assessment of hepatic steatosis before and after treatment, including liver histology, CAP, or abdominal ultrasound. RESULTS: Of 160 patients, 43 (26.88%) developed new-onset or progressive hepatic steatosis. CAP values increased by 24.34 dB/m, and ultrasound-detected steatosis prevalence rose from 21.28% to 42.55%. Elevated triglyceride levels at 6 months were independently associated with new-onset or progressive hepatic steatosis. DISCUSSION: Long-term GCs therapy was associated with a measurable increase in hepatic steatosis in patients with AIH across complementary assessment modalities. Six-month triglyceride levels may serve as an early metabolic marker for identifying patients at increased risk, supporting dynamic metabolic and steatosis monitoring during long-term immunosuppressive treatment.