Elsevier

Journal of Hepatology

Volume 31, Issue 5, November 1999, Pages 860-866
Journal of Hepatology

Chronic liver disease in the extremely elderly of 80 years or more: clinical characteristics, prognosis and patient survival analysis

https://doi.org/10.1016/S0168-8278(99)80287-6Get rights and content

Abstract

Background/Aims: This study aimed to elucidate the clinical characteristics of patients with chronic liver disease aged 80 years or more, especially the factors affecting prognosis and carcinogenesis.

Methods: A total of 135 patients aged 80 years or above were divided into chronic liver disease without cirrhosis (non-LC) and cirrhosis (LC) groups according to the severity of fibrosis, and the clinical characteristics and prognoses were evaluated.

Results: Seventy-three (54.1%) of 135 patients were in the LC group and 79 patients (58.5%) had hepatitis C virus. Various concomitant diseases were seen in 122 patients (90.4%). Liver-related deaths occurred in only 19 (36.5%) of 52 patients who died during observation, although 28 patients (53.8%) had liver cancer at the time of death. Cumulative survival rates in the non-LC and the LC groups were 85.7% and 58.8% at the 5th year, and 69.4% and 19.4% at the 9th year, respectively. Cumulative liver cancer appearance rates in the non-LC and the LC groups were 1.6% and 6.1% at the 1st year, 12.4% and 19.9% at the 5th year, and 12.4% and 32.0% at the 7th year, respectively. A multivariate Cox regression analysis revealed that the presence of liver cancer (p=0.0001), platelet count (p=0.0242), and fibrotic stage (p=0.0118) were independently associated with survival period, and alfa-fetoprotein (p=0.0194) and bilirubin (p=0.0282) were independently associated with carcinogenesis.

Conclusions: Cirrhosis is the major risk factor affecting the prognosis. On the other hand, we must pay more attention to concomitant diseases specific to advanced age.

Section snippets

Study population and background

Of the consecutive patients with chronic liver disease who came to Toranomon Hospital, Tokyo, Japan, from May 1965 to October 1998, 135 patients aged 80 years or more were analyzed: 72 men and 63 women. The diagnosis of liver cirrhosis was made histologically or morphologically from the results of ultrasonography (US) or computed tomography (CT). Thirty-one patients underwent liver biopsy before the age of 65. Increased serum alanine aminotransferase levels (greater than 1.5 times normal) or

Etiologies and clinical stage at the start of observations

Table 1 summarizes the profiles and laboratory data of all patients at the start of observations. Of 135 patients, 62 cases (45.9%) were in the non-LC group with a male-to-female ratio of 1.58; and 73 cases (54.1%) were in the LC group with a male-to-female ratio of 0.87. The number of female patients in the LC group was relatively greater than the number of male patients (p=0.0880). Among 117 patients without liver cancer at the start of observations, albumin and platelet count in the LC group

Discussion

With the arrival of the aging society, clinicians often encounter patients at the great age of 80 or more, and the subject of chronic liver disease in such extremely elderly patients is receiving more specific attention. But the clinical characteristics and the long-term prognosis of their disease still remain obscure because no mass study has focused on them, and following up such old patients continuously is difficult. In this study, we investigated 135 patients with chronic liver disease

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