title: Autoimmune hepatitis (AIH) in the elderly: a systematic retrospective analysis of a large group of consecutive patients with definite AIH followed at a tertiary referral centre.
abstract: OBJECTIVE
  A few reports have suggested that AIH may be less severe in the elderly and may be underdiagnosed, but there is a paucity of data.
  
  
  METHODS
  We have undertaken a systematic analysis of 164 consecutive patients (36 males, 128 females) with definite AIH (median score 23, range 18-28) attending our clinics, comparing those presenting at age >60 years (Group 1, n=43) with those presenting at <60 years (Group 2, n=121).
  
  
  RESULTS
  Median (range) duration of follow-up was 9 years (1-28) in Group 1 and 14 years (1-33) in Group 2. Median ages (ranges) at presentation were: Group 1=65 (60-79) and Group 2=41 (6-59). Group 1 patients had a significantly increased incidence of ascites at presentation (p<0.001) and a lower incidence of relapse (42% vs. 70%, p=0.002), but there were no significant differences between the groups with respect to mode of onset (acute, insidious, asymptomatic), other clinical signs at presentation, biochemical parameters, types or titres of autoantibodies, incidence of histological cirrhosis, response to therapy or related side effects. There were also no significant differences in liver-related deaths or transplantation, or the frequencies of HLA DR3 or DR4 - although there was an increased frequency of the A1-B8-DR3/4 haplotype in Group 2 (40% vs. 22%, p=0.138).
  
  
  CONCLUSIONS
  These findings suggest that AIH often presents in older patients, who frequently have severe disease. Active management in these patients can lead to a normal life expectancy.
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: Thawab
authors.initials: T
authors.lastname: Al-Chalabi
authors.forename: Sylvia
authors.initials: S
authors.lastname: Boccato
authors.forename: Bernard C
authors.initials: BC
authors.lastname: Portmann
authors.forename: Ian G
authors.initials: IG
authors.lastname: McFarlane
authors.forename: Michael A
authors.initials: MA
authors.lastname: Heneghan
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015415:Biomarkers; D005260:Female; D005500:Follow-Up Studies; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers