Características diferenciales de la hepatitis autoinmune en adultos mayores colombianos: estudio de cohorte

Introduction: Elderly patients with autoimmune hepatitis (AIH) are a special population because of predisposition mediated by the human leukocyte antigen (HLA) system. An indolent and progressive course of the disease has been described. No data are known for the Latin American population. Objectives: This study compares clinical presentations, diagnoses, treatments, responses to treatment and course of disease for AIH patients who are over 65 years of age with those of AIH patients who are under 65. Methods: This is a retrospective cohort study of patients with HAI evaluated between January 2010 and December 2016. Statistical analyses used SPSS version 20.1. Results: Two hundred fourteen patients were included. Elderly patients had hypertension (34.5% vs 15.1%, p = 0.011), dyslipidemia (20.7% vs 5.9%, p = 0.006) and cardiovascular disease (17.2% vs 2.7%, p = 0.001) more frequently than did the younger patients. In addition, the elderly had a higher frequency of cirrhosis confirmed histologically and radiologically (55.1% vs. 33.5%, p = 0.024) at the time of diagnosis. Older patients had a higher rate of biochemical remission resulting from treatment (100% vs 83.9%, p = 0.022). There were no differences in hepatic analyses, autoantibodies, type of pharmacological treatment received, relapses, adverse effects related to treatment, requirements for liver transplantation and deaths. Conclusion: AIH affects the Colombian adult population at all ages and should be considered in the diagnostic approach of elderly patients who have liver disease because this group has a higher frequency of cirrhosis at the time of diagnosis. Early diagnosis is important because treatment is effective and well tolerated.