Impact of age on autoimmune hepatitis: A comparative study of patients diagnosed before and after sixty

Autoimmune hepatitis (AIH) is characterized by inflammation, hepatocyte necrosis, autoantibodies, and elevated serum globulin levels. It can present at any age, with peaks reported at 30 years and after 60 years. No national studies have evaluated the impact of age at diagnosis on AIH presentation and outcomes.

To compare the presentation and progression of AIH in patients diagnosed before and after the age of 60 years.

This cross-sectional analytical study included biopsy-confirmed AIH patients with at least one year of follow-up at Hospital Clínico Universidad de Chile, Santiago, Chile. Demographic, clinical, laboratory, and treatment response variables were analyzed. Group comparisons (diagnosis before or after 60 years) were performed using the χ ² test for qualitative variables and the Mann-Whitney test for quantitative variables (significance P < 0.05).

Ninety-seven AIH patients were included; 85% were female, with a median age of 53 years (range 18-83 years). Forty-one percent were diagnosed after the age of 60. Younger patients exhibited more jaundice at diagnosis (75% vs 44%, P = 0.02) and higher aminotransferases levels (median alanine aminotransferase 998 IU/mL vs 334 IU/mL, P = 0.0002). In contrast, at diagnosis, ascites was more prevalent in patients over 60 (13% vs 2%, P = 0.028), and advanced fibrosis (F3-F4) was more frequent in this group (68% vs 41%, P = 0.020). Biochemical response at six months was similar between groups, despite lower corticosteroid doses being administered to patients over 60 years.

AIH in patients over 60 presented with less jaundice, lower aminotransferases levels, greater fibrosis, and more ascites. Biochemical response was similar independently of age and despite lower prednisone doses administered in patients over 60 years.