Clinico-biochemical and morphological mapping in chronic liver diseases in patients of the senior age group

Diagnosis of chronic liver diseases in elderly patients has its own features due to polymorbidity, multiple organ failure, being subtle the course of the disease.

The purpose of the study was to identify correlations of inflammation biochemical parameters and hepatocellular failure with histology in chronic hepatitis (CH) and liver cirrhosis (LC) in elderly patients.

Materials and methods. The study included medical records of patients with chronic liver disease (CLD) who died in the Clinical Hospital for War Veterans of Saint Petersburg between 2009 and 2015 (with the average age of 81 year). The diagnosis of chronic hepatitis (45 cases) and chronic cirrhosis (54 cases) was confirmed by postmortem examination. Morphological changes in the liver were described according to Knodell creteria. The degree of inflammatory activity in the liver was evaluated in points (0.1 to 3.0) depending on the level of AST, ALT, γ-globulin, alkaline phosphatase, γ-GTP, bilirubin. For similar scoring severity hepatocellular insufficiency (0.1–3.0) considered total protein, albumin, prothrombin index, fibrinogen. For cirrhotic patients the Child-Pugh criteria were also used.

Results. Chronic liver disease (CLD) — hepatitis and cirrhosis of the elderly is detected in 1,5% of cases. In most cases, CLD develop secondary to diseases of the cardiovascular system, and are accompanied by subtle symptoms, which limits their life-time diagnosis. The integral evaluation of the process activity degree according to biochemical indices was significantly higher in the group of chronic hepatitis than in the group of liver cirrhosis. Correlations of the inflammation bichemical parameters (AST and / or ALT, γ-globulin, alkaline phosphatase, γ-GTP) having a degree of Knodell Histological Activity Group chronic hepatitis and cirrhosis have not been established. The study established correlation of histological activity with total bilirubin levels in both groups of CLD. Integral assessment of hepatocellular deficiency by biochemical indicators of liver cirrhosis group was higher than in the group of chronic hepatitis.