Management of Autoimmune Hepatitis in the Elderly
Management of Autoimmune Hepatitis in the Elderly
We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of the databases MEDLINE (from 1946), PubMed (from 1946), EMBASE (from 1949) through to November 2013 was carried out to identify relevant articles. The search used the terms 'autoimmune hepatitis in the elderly', 'autoimmune hepatitis' AND 'elderly', 'autoimmune hepatitis' AND 'aging', 'autoimmune hepatitis' AND 'older patients', or 'autoimmune hepatitis' AND 'older', and these terms were searched as text word and as exploded medical subject headings where possible. The reference lists of relevant articles were also searched for appropriate studies. No language restrictions were used in either the search or study selection. No quality assessment was undertaken. A search for unpublished literature was not performed.
We included studies that specifically looked at the differences in the presentation, and/or the treatment response, and other aspects of autoimmune hepatitis between the elderly and younger patients.
The data extraction was performed using a standardised data extraction form, collecting information on the publication year, study design, total sample size, the percentage of old patients, temporal direction, population type, country, continent, mean age at presentation, number of adjusted variables, the most common mode of presentation, the differences in presentation, the rate of cirrhosis, the time to diagnosis, the rate of other autoimmune diseases, the associated HLA haplotype, the treatment response, the rate of relapses and the tolerability of the treatment. Quality of the studies was not assessed and authors were not contacted for missing data.
Pooled odds ratios and 95% confidence intervals were calculated for the various aspects of autoimmune hepatitis in the elderly and young patients using a random-effects model. We tested heterogeneity with Cochran's Q statistics, with P < 0.10 indicating heterogeneity, and quantified the degree of heterogeneity using the I statistics, which represents the percentage of the total variability across studies, which is due to heterogeneity. Values of 25%, 50%, and 75% corresponded to low, moderate and high degrees of heterogeneity respectively. We quantified publication bias using the Egger's regression model, with the effect of bias assessed during the fail-safe number method. The fail-safe number was the number of studies that we would need to have missed for our observed result to be nullified to statistical nonsignificance at the P < 0.05 level. Publication bias is generally regarded as a concern if the fail-safe number is less than 5n + 10, with n being the number of studies included in the meta-analysis. All analyses were performed with Comprehensive Meta-analysis (version 2.0), Biostat, Englwood, NJ (1995).
Methods
Study Protocol
We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of the databases MEDLINE (from 1946), PubMed (from 1946), EMBASE (from 1949) through to November 2013 was carried out to identify relevant articles. The search used the terms 'autoimmune hepatitis in the elderly', 'autoimmune hepatitis' AND 'elderly', 'autoimmune hepatitis' AND 'aging', 'autoimmune hepatitis' AND 'older patients', or 'autoimmune hepatitis' AND 'older', and these terms were searched as text word and as exploded medical subject headings where possible. The reference lists of relevant articles were also searched for appropriate studies. No language restrictions were used in either the search or study selection. No quality assessment was undertaken. A search for unpublished literature was not performed.
Study Selection
We included studies that specifically looked at the differences in the presentation, and/or the treatment response, and other aspects of autoimmune hepatitis between the elderly and younger patients.
Data Extraction
The data extraction was performed using a standardised data extraction form, collecting information on the publication year, study design, total sample size, the percentage of old patients, temporal direction, population type, country, continent, mean age at presentation, number of adjusted variables, the most common mode of presentation, the differences in presentation, the rate of cirrhosis, the time to diagnosis, the rate of other autoimmune diseases, the associated HLA haplotype, the treatment response, the rate of relapses and the tolerability of the treatment. Quality of the studies was not assessed and authors were not contacted for missing data.
Statistical Analysis
Pooled odds ratios and 95% confidence intervals were calculated for the various aspects of autoimmune hepatitis in the elderly and young patients using a random-effects model. We tested heterogeneity with Cochran's Q statistics, with P < 0.10 indicating heterogeneity, and quantified the degree of heterogeneity using the I statistics, which represents the percentage of the total variability across studies, which is due to heterogeneity. Values of 25%, 50%, and 75% corresponded to low, moderate and high degrees of heterogeneity respectively. We quantified publication bias using the Egger's regression model, with the effect of bias assessed during the fail-safe number method. The fail-safe number was the number of studies that we would need to have missed for our observed result to be nullified to statistical nonsignificance at the P < 0.05 level. Publication bias is generally regarded as a concern if the fail-safe number is less than 5n + 10, with n being the number of studies included in the meta-analysis. All analyses were performed with Comprehensive Meta-analysis (version 2.0), Biostat, Englwood, NJ (1995).