Course and prognosis of chronic liver diseases in the elderly

Authors:

Stolov Sergey Valentinovich – Grand PhD in Medical sciences (Dr. Med. Sci), assistant professor, Head of the Department of Therapy 1 of the Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: sv100lov@gmail.com, https://orcid.org/0000-0002-3431-1224.

Makarova Olga Vladimirovna – PhD in Medical sciences (Cand. Med. Sci.), Associate Professor of the Department of Therapy 1 of the Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: olgamak2012@mail.ru, https://orcid.org/0000-0002-1849-0648.

Rodionova Anna Yuryevna – PhD in Medical sciences (Cand. Med. Sci.), Associate Professor of the Department of Therapy 1 of the Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: a.rod84@mail.ru, https://orcid.org/0000-0002-0186-7621.

Annotation:

Introduction. Chronic liver diseases are often found in the structure of diseases and mortality in elderly and senile people. Diagnostics, course, prognosis and rehabilitation potential of chronic hepatitis and liver cirrhosis in this age group have a number of features due to the latent course of the disease, severe polymorbidity, polypharmacy. At the same time, the frequency of occurrence of chronic liver diseases, their impact on the course of concomitant diseases have not been sufficiently studied, approaches to rational treatment and rehabilitation of such patients require study.

Aim. The aim of the study is to establish the characteristics of the course of hepatitis and liver cirrhosis in elderly and senile individuals, to compare clinical and laboratory indicators with the results of pathological examination, to assess their prognostic value and impact on the course of concomitant diseases.

Materials and methods. A total of 118 medical records of patients with chronic liver diseases who died between 2009 and 2023 were studied. The diagnosis of chronic hepatitis (54 cases) and liver cirrhosis (64 cases) was confirmed by the results of pathological examination. The histological activity index was calculated according to Knodell (1981). The degree of activity of the inflammatory process in the liver was assessed based on laboratory test data depending on the level of AST, ALT, y-globulins, alkaline phosphatase, g-GTP, and bilirubin. Total protein, albumin, and prothrombin time (prothrombin index) were taken into account to assess the severity of hepatocellular insufficiency. The Child-Pugh criteria were used for patients with liver cirrhosis. Verification and severity of concomitant diseases were assessed in accordance with clinical guidelines for this nosological entity.

Results. Chronic liver diseases (hepatitis and cirrhosis) in elderly people are detected with a frequency of 1.5%. In most cases, chronic diseases occur against the background of cardiovascular diseases, accompanied by an erased clinical picture, which limits the possibilities of their lifetime diagnosis. Correlation of the complex of biochemical inflammation indices with the degree of histological activity according to Knodel in the groups of chronic hepatitis and liver cirrhosis has not been established. The point assessment of hepatocellular insufficiency according to biochemical indices in the liver cirrhosis group is higher than in the chronic hepatitis group. The prognosis for chronic liver diseases in elderly people is determined by the severity of concomitant diseases.

Discussion. According to the conducted pathological study, chronic liver diseases in the elderly are relatively rare, which differs significantly from the data of most other authors. The reasons for the different rates of occurrence of chronic liver diseases are due to the criteria for their assessment, since biochemical markers are most often used for verification, less often morphological ones. In addition, the group of chronic liver diseases traditionally includes liver steatosis, cardiac liver fibrosis, and reactive hepatitis. Chronic liver diseases are typical for younger people diagnosed with viral, toxic, autoimmune hepatitis and liver cirrhosis, characterized by rapid progression and higher mortality without a tendency to chronicity and prolongation in adulthood. In elderly people, chronic liver diseases are relatively benign, and life expectancy in this age group largely depends on concomitant pathology, primarily cardiovascular.

Summary. Chronic liver diseases – hepatitis and cirrhosis – are detected in elderly people quite rarely, according to the study. In most cases, they are not the direct cause of death, proceed without active clinical symptoms, are accompanied by severe polymorbidity, which limits the possibilities of their lifetime diagnosis and successful rehabilitation.

List of cited literature:

1. Kamoldinov MM, Gaffarov HA. Rasprostranennost’ infektsii HCV v razlichnykh gruppakh detei i vzroslykh [Prevalence of HCV infections in different groups of children and adults]. Ekonomika i sotsium [Economy and society]. 2022;1-1(92):464-7. (In Russian).

2. Semmler G, Alonso Lopez S, Pons M, Lens S, et al. Long-term outcome and risk stratification in compensated advanced chronic liver disease after HCV-cure. Hepatology. 2025;81(2):609-624. DOI: 10.1097/HEP.0000000000001005

3. Kim JH, Kim SE, Song DS, Kim HY, et al. Aetiology of chronic liver disease is a valuable factor for stratifying adverse outcomes of acute decompensation: prospective observational study. Ann Med. 2025;57(1):2428431. DOI: 10.1080/07853890.2024.2428431

4. Shchekotova AP Tsirrozy pecheni [Liver cirrhosis]. Permskii meditsinskii zhurnal [Perm Medical Journal]. 2022;39(4):41-57 (In Russian).

5. Tsirroz i fibroz pecheni [Liver cirrhosis and fibrosis.]. Klinicheskie rekomendatsii [Clinical guidelines.]. Moskva [Moscow], 2021. 99 p. (In Russian).

6. Bokhonov MS, Galitsina LE, Sitnikov IG. Osobennosti kliniki khronicheskogo gepatita S u bol’nykh pozhilogo vozrasta. Features of the clinical picture of chronic hepatitis C in elderly patients]. Vestnik Ivanovskoi meditsinskoi akademii [Bulletin of the Ivanovo Medical Academy]. 2023;28(2):27-30 (In Russian).

7. Nealkogol’naya zhirovaya bolezn’ pecheni [Non-alcoholic fatty liver disease]. Klinicheskie rekomendatsii [Clinical guidelines]. Moskva [Moscow], 2024. 151 р. (In Russian).

8. Khronicheskii virusnyi gepatit В [Chronic viral hepatitis B]. Klinicheskie rekomendatsii [Clinical guidelines]. Moskva [Moscow], 2024. 99 р. (In Russian).

9. Khronicheskii virusnyi gepatit С [Chronic viral hepatitis C.]. Klinicheskie rekomendatsii [Clinical guidelines]. Moskva [Moscow], 2024. 71 p. (In Russian).

10. Hallager S, Ladelund S, Christensen PB, Kjsr M, et al. Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response. Clin Epidemiol. 2017;9:501-16. DOI: 10.2147/CLEP.S132072

11. Mikhailova YuV, Sterlikov SA, Gromov AV. Smertnost’ ot virusnykh gepatitov v Rossiiskoi Federatsii (analiticheskii obzor) [Mortalityfrom viral hepatitis in the Russian Federation (analytical review)]. Sovremennye problemy zdravookhraneniya i meditsinskoi statistiki [Modern problems of health care and medical statistics]. 2022(1):414-37. (In Russian).

12. Gastroenterologiya. Natsional’noe rukovodstvo, pod red. V.T. Ivashkina, T.L. Lapinoi [Gastroenterology. National guidelines edited by VT Ivashkin, TL Lapina]. Moskva: GEOTAR-Media [Moscow: GEOTAR Media], 2018. 464 p. (In Russian).

13. Bakulin IG, Oganezova IA, Skalinskaya EV, Skazyvaeva EV. Tsirroz pecheni i upravlenie riskami oslozhnenii [Liver cirrhosis and risk management of complications]. Terapevticheskii arkhiv [Therapeutic archive]. 2021;93(8): 963-8. (In Russian).

14. Spravochnik po mediko-sotsial’noi ekspertize i reabilitatsii v 2-kh tomakh, pod red. V.G. Pomnikova, 5-e izd, pererab. i dop. [Handbook of medical and social expertise and rehabilitation in 2 volumes edited by VG Pomnikov, 5th ed., revised and enlarged]. SPb: Gippokrat [St. Petersburg: Gipppokrat], 2021. Tom 1. p. 227-58. (In Russian).

15. Ma Y, Yuan Y, Lu Y, Li S. A pilot clinical trial of exercise program for elderly patients with cirrhosis and frailty: comprehensive exercise rehabilitation intervention. Eur J Gastroenterol Hepatol. 2025;37(3):313-319. DOI: 10.1097/MEG.0000000000002864.