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Clinical features and natural mortality of chronic active hepatitis in Hong Kong
Insights
Chronic active hepatitis (CAH) in Hong Kong affects middle-aged men, with shrunken livers and enlarged spleens. Survival is poor, with high mortality and varied outcomes based on initial symptoms.
Area of Science:
- Hepatology
- Clinical Medicine
- Gastroenterology
Background:
- Chronic active hepatitis (CAH) is a significant liver disease with varying clinical presentations and outcomes globally.
- Understanding regional differences in CAH is crucial for effective patient management.
Purpose of the Study:
- To investigate the clinical characteristics and survival rates of non-alcoholic chronic active hepatitis (CAH) patients in Hong Kong.
- To compare CAH patient profiles between Hong Kong and other reported populations, such as Australia and Asia.
Main Methods:
- Retrospective review of 298 non-alcoholic patients with histologically confirmed CAH in Hong Kong.
- Analysis of clinical presentation, autopsy findings (liver mass, spleen size), and survival data.
- Statistical correlation between presenting symptoms, modes of death, and survival outcomes.
Main Results:
- The study population comprised 298 patients with a male:female ratio of 3:1 and a mean age of 47.3 years.
- CAH patients exhibited shrunken livers (mean mass 887 gm) and 98% had splenomegaly.
- An annual mortality rate of approximately 13% was observed, with survival varying based on initial symptoms (splenomegaly alone best, hepatic decompensation worst).
- Modes of death strongly correlated with initial chief complaints (p < 0.001).
Conclusions:
- This study provides a comprehensive clinical profile of CAH in Hong Kong, highlighting significant differences from other reported cohorts.
- Clinical presentation, particularly splenomegaly, ascites, gastrointestinal hemorrhage, and hepatic decompensation, significantly impacts patient survival.
- The findings underscore the importance of regional data in understanding and managing CAH.
Abstract:
To study the clinical picture and survival of chronic active hepatitis (CAH) in Hong Kong, the records of 298 non-alcoholic patients with histologically proven CAH were reviewed. The male:female ratio was 3:1. The mean age (+/- SD) on presentation was 47.3 (+/- 13.1) years. The liver was shrunken and the mean mass (+/- SD) at autopsy was 887 gm (+/- 266) compared to 1343 gm (+/- 172) in cases without liver disease. The spleen was enlarged to 2 to 20 cm below the left costal margin in 98% of cases. The survival graph showed an annual mortality of approximately 13%, without a tendency to flatten out within ten years of diagnosis. Survival was best in patients presenting with splenomegaly alone, average in those presenting with ascites or gastrointestinal haemorrhage and worst in those presenting with hepatic decompensation. The modes of death were significantly correlated with the chief complaints on first presentation (p less than 0.001). The study documented the clinical aspects of CAH in Hong Kong and amplified the differences reported among CAH patients between Australia and Asia.