Etiology of abnormal liver function in elderly patients with no viral hepatitis based on pathological diagnosis: An analysis of 50 cases

Objective To investigate the pathology,clinical features,population features,and etiology of non-viral hepatitis-related abnormal liver function in the elderly. Methods A retrospective analysis was performed for 50 elderly patients,with abnormal liver function as disease onset for the first time,who were hospitalized and treated in Beijing YouAn Hospital,Capital Medical University,from January2017 to September 2019. Abnormal liver function was defined as elevated alanine aminotransferase( ≥2 × upper limit of normal),with or without the increases in the serum levels of aspartate aminotransferase,total bilirubin,alkaline phosphatase,and gamma-glutamyl transpeptidase,and there was no limit for the duration of abnormal liver function. According to the method for obtaining pathological specimens,the patients were divided into percutaneous liver biopsy group and transjugular liver biopsy group. The etiology of abnormal liver function was analyzed,and clinical features and laboratory markers were summarized. The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Results A total of 50 patients were enrolled,with a mean age of 64. 7 ± 3. 7 years,and there were 19 male patients and 31 female patients. Of all patients,21 underwent transjugular liver biopsy and 29 underwent percutaneous liver biopsy. Pathological examination showed that 20 patients( 40. 0%) were diagnosed with drug-induced liver injury,among whom 3 had autoimmune phenomena,1 had liver failure,and 4 had hepatic veno-occlusive disease/hepatic sinusoidal obstruction syndrome; 5 patients( 10. 0%) were diagnosed with autoimmune liver disease,among whom 3 had primary biliary cholangitis and 2 had autoimmune hepatitis( 1 patient already had liver cirrhosis); 4 patients( 8. 0%) were diagnosed with nonalcoholic fatty liver disease. The etiology was not determined for 16 patients( 32. 0%),among whom 8 had liver cirrhosis,6 had hepatitis,and 2 had bile duct disease. In addition,there were 2 patients with non-cirrhotic portal hypertension( 4. 0%),1 patient with amyloidosis( 2. 0%),and 2 patients with liver failure( 4. 0%). Conclusion Drug-induced liver injury has the highest incidence rate among non-viral hepatitis-related abnormal liver function in the elderly,which is often associated with the use of drugs for chronic diseases and Chinese patent drugs. Transjugular liver biopsy may help to determine the etiology of severe liver diseases.