Association Between Black Race and Presentation and Liver-Related Outcomes of Patients With Autoimmune Hepatitis

Ynto S. de Boer, Alessio Gerussi, Floris F. van den Brand, Guan-Wee Wong, Neil Halliday, Rodrigo Liberal, Joost P. H. Drenth, Douglas Thorburn, Gerd Bouma, Dutch Autoimmune Hepatitis Study group, N. M. van Gerven, U. Beuers, K. J. van Erpecum, H. R. van Buuren, J. W. den Ouden, J. T. Brouwer, J. M. Vrolijk, R. C. Verdonk, B. van Hoek, G. H. Koek & 13 others M. M. J. Guichelaar, E. Bloemena, C. M. J. van Nieuwkerk, T. C. M. A. Schreuder, E. J. van der Wouden, J. J. M. van Meyel, L. C. Baak, P. H. G. M. Stadhouders, M. Klemt-Kropp, M. A. M. T. Verhagen, A. Bhalla, J. Ph. Kuijvenhoven, Michael A. Heneghan

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction & Aims: Small studies have found that black patients with autoimmune hepatitis (AIH) present with more aggressive disease. We aimed to characterize the presentation and outcome in black and white patients with AIH. Methods: We performed a retrospective study, collecting information from databases of patients with AIH attending the Institute of Liver studies at King's College Hospital, London (1971–October 2015, the Royal Free Hospital, London (1982 through December 2016) and the multicenter Dutch Autoimmune Hepatitis Study Group cohort (2006–August 2016). We identified 88 black patients with AIH and we compared their clinical characteristics and outcomes to 897 white patients with AIH. Results: Black patients presented at a younger age (median 38 years vs 45 years) (P =.007), had higher IgG levels (mean 31.0 mg/dL vs 27.5 mg/dL) (P =.04), but there were no significant differences between groups in auto-antibody profiles, International AIH Group scores, or sex distribution of disease. A higher proportion of black patients had systemic lupus erythematosus (10%) than white patients (2%) (P ≤.001). There was no significant difference in proportions of patients with a response to standard therapy (86% for black patients vs 91% for white patients; P =.20) or in rate of relapse (57% vs 50%; P =.3). Despite this, black patients had an increased risk of liver transplantation and liver-related death (hazard ratio 2.4, 95% confidence interval, 1.4–4.0; P <.001). Overall mortality was similar between the two groups. Conclusion: In a comparison of black and white patients with AIH in Europe, we found that black patients present at a younger age, have higher levels of IgG levels, and a greater proportion have SLE. We also found black patients to have a greater risk of liver transplantation and liver-related mortality, indicating more aggressive disease.
Original languageEnglish
Pages (from-to)1616-1624.e2
JournalClinical Gastroenterology and Hepatology
Volume17
Issue number8
DOIs
Publication statusPublished - 1 Jul 2019

Cite this

de Boer, Ynto S. ; Gerussi, Alessio ; van den Brand, Floris F. ; Wong, Guan-Wee ; Halliday, Neil ; Liberal, Rodrigo ; Drenth, Joost P. H. ; Thorburn, Douglas ; Bouma, Gerd ; Dutch Autoimmune Hepatitis Study group ; van Gerven, N. M. ; Beuers, U. ; van Erpecum, K. J. ; van Buuren, H. R. ; den Ouden, J. W. ; Brouwer, J. T. ; Vrolijk, J. M. ; Verdonk, R. C. ; van Hoek, B. ; Koek, G. H. ; Guichelaar, M. M. J. ; Bloemena, E. ; van Nieuwkerk, C. M. J. ; Schreuder, T. C. M. A. ; van der Wouden, E. J. ; van Meyel, J. J. M. ; Baak, L. C. ; Stadhouders, P. H. G. M. ; Klemt-Kropp, M. ; Verhagen, M. A. M. T. ; Bhalla, A. ; Kuijvenhoven, J. Ph. ; Heneghan, Michael A. / Association Between Black Race and Presentation and Liver-Related Outcomes of Patients With Autoimmune Hepatitis. In: Clinical Gastroenterology and Hepatology. 2019 ; Vol. 17, No. 8. pp. 1616-1624.e2.
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title = "Association Between Black Race and Presentation and Liver-Related Outcomes of Patients With Autoimmune Hepatitis",
abstract = "Introduction & Aims: Small studies have found that black patients with autoimmune hepatitis (AIH) present with more aggressive disease. We aimed to characterize the presentation and outcome in black and white patients with AIH. Methods: We performed a retrospective study, collecting information from databases of patients with AIH attending the Institute of Liver studies at King's College Hospital, London (1971–October 2015, the Royal Free Hospital, London (1982 through December 2016) and the multicenter Dutch Autoimmune Hepatitis Study Group cohort (2006–August 2016). We identified 88 black patients with AIH and we compared their clinical characteristics and outcomes to 897 white patients with AIH. Results: Black patients presented at a younger age (median 38 years vs 45 years) (P =.007), had higher IgG levels (mean 31.0 mg/dL vs 27.5 mg/dL) (P =.04), but there were no significant differences between groups in auto-antibody profiles, International AIH Group scores, or sex distribution of disease. A higher proportion of black patients had systemic lupus erythematosus (10{\%}) than white patients (2{\%}) (P ≤.001). There was no significant difference in proportions of patients with a response to standard therapy (86{\%} for black patients vs 91{\%} for white patients; P =.20) or in rate of relapse (57{\%} vs 50{\%}; P =.3). Despite this, black patients had an increased risk of liver transplantation and liver-related death (hazard ratio 2.4, 95{\%} confidence interval, 1.4–4.0; P <.001). Overall mortality was similar between the two groups. Conclusion: In a comparison of black and white patients with AIH in Europe, we found that black patients present at a younger age, have higher levels of IgG levels, and a greater proportion have SLE. We also found black patients to have a greater risk of liver transplantation and liver-related mortality, indicating more aggressive disease.",
author = "{de Boer}, {Ynto S.} and Alessio Gerussi and {van den Brand}, {Floris F.} and Guan-Wee Wong and Neil Halliday and Rodrigo Liberal and Drenth, {Joost P. H.} and Douglas Thorburn and Gerd Bouma and {Dutch Autoimmune Hepatitis Study group} and {van Gerven}, {N. M.} and U. Beuers and {van Erpecum}, {K. J.} and {van Buuren}, {H. R.} and {den Ouden}, {J. W.} and Brouwer, {J. T.} and Vrolijk, {J. M.} and Verdonk, {R. C.} and {van Hoek}, B. and Koek, {G. H.} and Guichelaar, {M. M. J.} and E. Bloemena and {van Nieuwkerk}, {C. M. J.} and Schreuder, {T. C. M. A.} and {van der Wouden}, {E. J.} and {van Meyel}, {J. J. M.} and Baak, {L. C.} and Stadhouders, {P. H. G. M.} and M. Klemt-Kropp and Verhagen, {M. A. M. T.} and A. Bhalla and Kuijvenhoven, {J. Ph.} and Heneghan, {Michael A.}",
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de Boer, YS, Gerussi, A, van den Brand, FF, Wong, G-W, Halliday, N, Liberal, R, Drenth, JPH, Thorburn, D, Bouma, G, Dutch Autoimmune Hepatitis Study group, van Gerven, NM, Beuers, U, van Erpecum, KJ, van Buuren, HR, den Ouden, JW, Brouwer, JT, Vrolijk, JM, Verdonk, RC, van Hoek, B, Koek, GH, Guichelaar, MMJ, Bloemena, E, van Nieuwkerk, CMJ, Schreuder, TCMA, van der Wouden, EJ, van Meyel, JJM, Baak, LC, Stadhouders, PHGM, Klemt-Kropp, M, Verhagen, MAMT, Bhalla, A, Kuijvenhoven, JP & Heneghan, MA 2019, 'Association Between Black Race and Presentation and Liver-Related Outcomes of Patients With Autoimmune Hepatitis' Clinical Gastroenterology and Hepatology, vol. 17, no. 8, pp. 1616-1624.e2. https://doi.org/10.1016/j.cgh.2018.11.028

Association Between Black Race and Presentation and Liver-Related Outcomes of Patients With Autoimmune Hepatitis. / de Boer, Ynto S.; Gerussi, Alessio; van den Brand, Floris F.; Wong, Guan-Wee; Halliday, Neil; Liberal, Rodrigo; Drenth, Joost P. H.; Thorburn, Douglas; Bouma, Gerd; Dutch Autoimmune Hepatitis Study group; van Gerven, N. M.; Beuers, U.; van Erpecum, K. J.; van Buuren, H. R.; den Ouden, J. W.; Brouwer, J. T.; Vrolijk, J. M.; Verdonk, R. C.; van Hoek, B.; Koek, G. H.; Guichelaar, M. M. J.; Bloemena, E.; van Nieuwkerk, C. M. J.; Schreuder, T. C. M. A.; van der Wouden, E. J.; van Meyel, J. J. M.; Baak, L. C.; Stadhouders, P. H. G. M.; Klemt-Kropp, M.; Verhagen, M. A. M. T.; Bhalla, A.; Kuijvenhoven, J. Ph.; Heneghan, Michael A.

In: Clinical Gastroenterology and Hepatology, Vol. 17, No. 8, 01.07.2019, p. 1616-1624.e2.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Association Between Black Race and Presentation and Liver-Related Outcomes of Patients With Autoimmune Hepatitis

AU - de Boer, Ynto S.

AU - Gerussi, Alessio

AU - van den Brand, Floris F.

AU - Wong, Guan-Wee

AU - Halliday, Neil

AU - Liberal, Rodrigo

AU - Drenth, Joost P. H.

AU - Thorburn, Douglas

AU - Bouma, Gerd

AU - Dutch Autoimmune Hepatitis Study group

AU - van Gerven, N. M.

AU - Beuers, U.

AU - van Erpecum, K. J.

AU - van Buuren, H. R.

AU - den Ouden, J. W.

AU - Brouwer, J. T.

AU - Vrolijk, J. M.

AU - Verdonk, R. C.

AU - van Hoek, B.

AU - Koek, G. H.

AU - Guichelaar, M. M. J.

AU - Bloemena, E.

AU - van Nieuwkerk, C. M. J.

AU - Schreuder, T. C. M. A.

AU - van der Wouden, E. J.

AU - van Meyel, J. J. M.

AU - Baak, L. C.

AU - Stadhouders, P. H. G. M.

AU - Klemt-Kropp, M.

AU - Verhagen, M. A. M. T.

AU - Bhalla, A.

AU - Kuijvenhoven, J. Ph.

AU - Heneghan, Michael A.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Introduction & Aims: Small studies have found that black patients with autoimmune hepatitis (AIH) present with more aggressive disease. We aimed to characterize the presentation and outcome in black and white patients with AIH. Methods: We performed a retrospective study, collecting information from databases of patients with AIH attending the Institute of Liver studies at King's College Hospital, London (1971–October 2015, the Royal Free Hospital, London (1982 through December 2016) and the multicenter Dutch Autoimmune Hepatitis Study Group cohort (2006–August 2016). We identified 88 black patients with AIH and we compared their clinical characteristics and outcomes to 897 white patients with AIH. Results: Black patients presented at a younger age (median 38 years vs 45 years) (P =.007), had higher IgG levels (mean 31.0 mg/dL vs 27.5 mg/dL) (P =.04), but there were no significant differences between groups in auto-antibody profiles, International AIH Group scores, or sex distribution of disease. A higher proportion of black patients had systemic lupus erythematosus (10%) than white patients (2%) (P ≤.001). There was no significant difference in proportions of patients with a response to standard therapy (86% for black patients vs 91% for white patients; P =.20) or in rate of relapse (57% vs 50%; P =.3). Despite this, black patients had an increased risk of liver transplantation and liver-related death (hazard ratio 2.4, 95% confidence interval, 1.4–4.0; P <.001). Overall mortality was similar between the two groups. Conclusion: In a comparison of black and white patients with AIH in Europe, we found that black patients present at a younger age, have higher levels of IgG levels, and a greater proportion have SLE. We also found black patients to have a greater risk of liver transplantation and liver-related mortality, indicating more aggressive disease.

AB - Introduction & Aims: Small studies have found that black patients with autoimmune hepatitis (AIH) present with more aggressive disease. We aimed to characterize the presentation and outcome in black and white patients with AIH. Methods: We performed a retrospective study, collecting information from databases of patients with AIH attending the Institute of Liver studies at King's College Hospital, London (1971–October 2015, the Royal Free Hospital, London (1982 through December 2016) and the multicenter Dutch Autoimmune Hepatitis Study Group cohort (2006–August 2016). We identified 88 black patients with AIH and we compared their clinical characteristics and outcomes to 897 white patients with AIH. Results: Black patients presented at a younger age (median 38 years vs 45 years) (P =.007), had higher IgG levels (mean 31.0 mg/dL vs 27.5 mg/dL) (P =.04), but there were no significant differences between groups in auto-antibody profiles, International AIH Group scores, or sex distribution of disease. A higher proportion of black patients had systemic lupus erythematosus (10%) than white patients (2%) (P ≤.001). There was no significant difference in proportions of patients with a response to standard therapy (86% for black patients vs 91% for white patients; P =.20) or in rate of relapse (57% vs 50%; P =.3). Despite this, black patients had an increased risk of liver transplantation and liver-related death (hazard ratio 2.4, 95% confidence interval, 1.4–4.0; P <.001). Overall mortality was similar between the two groups. Conclusion: In a comparison of black and white patients with AIH in Europe, we found that black patients present at a younger age, have higher levels of IgG levels, and a greater proportion have SLE. We also found black patients to have a greater risk of liver transplantation and liver-related mortality, indicating more aggressive disease.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85065019936&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/30471454

U2 - 10.1016/j.cgh.2018.11.028

DO - 10.1016/j.cgh.2018.11.028

M3 - Article

VL - 17

SP - 1616-1624.e2

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

IS - 8

ER -