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
C2 - 30471454
VL - 17
SP - 1616-1624.e2
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
SN - 1542-3565
IS - 8
ER -