Undiagnosed cirrhosis occurs frequently in the elderly and requires periodic follow ups and medical treatments

• Published in: Geriatrics & gerontology international Vol. 8; no. 3; pp. 198 - 203
• Main Authors: Fujimoto, Koichi, Sawabe, Motoji, Sasaki, Mina, Kino, Kenji, Arai, Tomio
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.09.2008; Blackwell Publishing Ltd
• Subjects: Aged; Aged, 80 and over; autopsy; Autopsy - statistics & numerical data; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - epidemiology; Cause of Death; Diagnostic Errors - statistics & numerical data; Female; Follow-Up Studies; Geriatrics; Humans; Incidence; Japan - epidemiology; Liver - pathology; Liver cirrhosis; Liver Cirrhosis - diagnosis; Liver Cirrhosis - epidemiology; Liver Cirrhosis - etiology; Liver Cirrhosis - pathology; liver neoplasms; Liver Neoplasms - complications; Liver Neoplasms - epidemiology; Male; Medical diagnosis; Medical treatment; Prevalence; Sex Factors; Japan
• ISSN: 1444-1586; 1447-0594
• DOI: 10.1111/j.1447-0594.2008.00470.x

Background:  Autopsy examinations frequently reveal undiagnosed cirrhosis, but its characteristics have rarely been addressed in the elderly. Methods:  From 1597 consecutive autopsies, those of patients with liver cirrhosis were selected and their clinicopathological findings were examined. Results:  Seventy‐six patients had liver cirrhosis; 18 of these patients (23.7%) were classified as an “undiagnosed” group and in that they had not been diagnosed as having cirrhosis before death. The remaining 58 patients were classified as a “clinical” group. Compared to the clinical group, the undiagnosed group demonstrated a significantly lower Child–Pugh score (7.1 ± 1.9 vs 8.6 ± 2.1; P < 0.01) and infrequent hepatocellular carcinoma (72.4% vs 5.6%; P < 0.0001). The undiagnosed group also demonstrated significantly lower complication rates of hepatic encephalopathy and esophageal varix, and a volume of ascites. The patients in the undiagnosed group were significantly older (79.9 ± 8.1 vs 74.2 ± 8.5 years; P < 0.01), and fewer patients died of liver‐related causes (17% vs 67.2%; P < 0.0001). The etiology of cirrhosis was unknown in five patients in the undiagnosed group, and seven patients did not show any suggestive symptoms or imaging signs. Conclusion:  Liver cirrhosis is often undiagnosed (23.7%) in the elderly. In the undiagnosed group, liver function was preserved and serious complications were infrequent. Because the diagnosis of cirrhosis leads to early identification of hepatocellular carcinoma and good prognosis, detailed examination and periodic follow ups should be performed when liver dysfunction is indicated, even in the elderly.