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Observational Study
. 2018 Jul 2;9(6):165.
doi: 10.1038/s41424-018-0028-1.

Role of age in presentation, response to therapy and outcome of autoimmune hepatitis

Martine A M C Baven-Pronk  1   2 , Maaike Biewenga  1 , Joanne J van Silfhout  1 , Aad P van den Berg  3 , Henk R van Buuren  4 , Bart J Verwer  5 , Carin M J van Nieuwkerk  5 , Gerd Bouma  5 , Bart van Hoek  6
Affiliations
Observational Study

Role of age in presentation, response to therapy and outcome of autoimmune hepatitis

Martine A M C Baven-Pronk et al. Clin Transl Gastroenterol. .

Abstract

Background: Few studies with diverging results and a small sample size have compared autoimmune hepatitis (AIH) in the elderly to younger patients.

Aim: To unbiasedly investigate the role of age in behaviour and treatment outcome of AIH.

Methods: All patients with probable or definite AIH type 1 in four tertiary academic centres were included in this retrospective-and since 2006 prospective-cohort study. Influence of age on presentation, remission and outcome of AIH were investigated.

Results: 359 patients were included. Presence of cirrhosis at AIH diagnosis around 30% was independent of age. ALAT was higher at age 30-60 years on AIH diagnosis, and above age 60 there were less acute onset, less jaundice and more concurrent autoimmune disease. Remission was reached in 80.2%, incomplete remission in 18.7%, only 1.1% (all aged 50-65) was treatment-refractory. Age was not an independent predictor of remission, while cirrhosis was. Above age 45 there was more diabetes, above age 60 more loss of remission. Rate of progression to cirrhosis was 10% in the 10 years after diagnosis and unrelated to age at AIH diagnosis. With onset below age 30, there was more development of decompensated cirrhosis over time. With higher age at AIH diagnosis there was a lower survival free of liver-related death or liver transplantation.

Conclusions: AIH presents at all ages. Age influences features at diagnosis, but not response to treatment, while survival without liver-related death or liver transplantation decreases with higher age at diagnosis.

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Conflict of interest statement

Guarantor of the article: Bart van Hoek

Specific author contributions: Martine Baven, Maaike Biewenga and Joanne van Silfhout performed the research, collected and analysed the data, Martine Baven and Bart van Hoek wrote the paper, Bart van Hoek designed the research, and Aad van den Berg, Henk van Buuren, Bart Verwer, Karin van Nieuwkerk and Gerd Bouma contributed to the collection of data. All authors approved the final version of the manuscript

Financial support: None

Potential competing interests: None

Figures

Fig. 1
Fig. 1
Distribution of age at diagnosis of AIH in 359 patients with AIH type one
Fig. 2
Fig. 2
Symptoms at AIH diagnosis up to 60 years and at or above 60 years of age
Fig. 3
Fig. 3
Remission over time with age below vs at/after age. a 25 (p = 0.022), b 30 (p = 0.089), c 40 (p = 0.619) or d 50 years at AIH diagnosis (p = 0.618)
Fig. 4
Fig. 4
Survival free of cirrhosis in those without cirrhosis at AIH diagnosis
Fig. 5
Fig. 5
Survival free of decompensated cirrhosis for patients with AIH diagnosis before vs at/after age a. 30 (p = 0.02), b 40 (p = 0.09), c 50 (p = 0.32) or d 60 years (p = 0.26)
Fig. 6
Fig. 6
Survival free of liver-related death or liver transplantation for those with AIH diagnosis before vs at/after age. a 30 (p = 0.0019), b 40 (p = 0.026), c 50 (p = 0.447) or d 60 years (p = 0.012)
See this image and copyright information in PMC

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