Clinical features of elderly patients with drug-induced liver injury

Objective To investigate the clinical features of elderly patients with drug-induced liver injury (DILI) .Methods A retrospective analysis was performed for the clinical data of elderly and young and middle-aged patients with DILI who were hospitalized in Dalian Municipal Central Hospital and The First Affiliated Hospital of Dalian Medical University from January 2010 to December 2015, including sex, age, underlying diseases, drugs causing liver injury, main clinical manifestations, liver function parameters [serum levels of alanine aminotransferase (ALT) , aspartate aminotransferase, alkaline phosphatase (ALP) , gamma-glutamyl transpeptidase (GGT) , albumin, total bilirubin (TBil) , and direct bilirubin (DBil) ], clinical type, treatment, and prognosis.The chi-square test was used for comparison of categorical data between groups, and the Kolmogorov-Smirnov Z test was used for comparison of continuous data between groups.Results Among the 350 patients with DILI, there were 98 elderly patients (elderly group) .The three most common underlying diseases in the elderly group were cerebrovascular and cardiovascular diseases (31.6%) , osteoarthropathy (26.5%) , and malignant tumor (18.4%) , and the elderly group had significantly higher proportions of patients with these diseases than the young and middle-aged group (31.6%/26.5%/18.4% vs 5.6%/6.3%/4.8%, χ2=42.825, 27.214, and 16.667, all P<0.001) .Among the drugs causing liver injury, traditional Chinese medicine was applied most frequently in the elderly group and the young and middle-aged group (53.1% and44.4%, respectively) , and the elderly group had significantly higher proportions of patients using cardiovascular drugs or antitumor drugs than the young and middle-aged group (26.5%/9.2% vs 4.0%/3.2%, χ2=38.925 and 5.513, P<0.001 and P=0.026) .The elderly group had significantly higher proportions of patients with jaundice (53.1%) or pruritus (22.4%) than the young and middle-aged group (40.5%, 7.1%) (χ2=4.536 and 16.331, P=0.041 and P<0.001) .The most common clinical type in both groups was hepatocellular injury type;compared with the young and middle-aged group, the elderly group had a significantly lower proportion of hepatocellular injury type cases (60.2% vs 81.7%, χ2=17.807, P<0.001) and a significantly higher proportion of cholestasis type cases (28.6% vs 7.9%, χ2=25.389, P<0.001) .Compared with the young and middle-aged group, the elderly group had significantly lower levels of ALT and ALP and significantly higher levels of GGT, TBil, and DBil (Z=-3.141, -2.599, -7.449, -10.277, and-9.278, all P<0.01) .Three patients in the elderly group and one in the young and middle-aged group died during hospitalization.Conclusion Underlying diseases and drugs causing liver injury in elderly patients with DILI are different from those in young and middle-aged patients, and the elderly patients have a higher proportion of cholestasis type cases compared with the young and middle-aged patients.Therefore, prevention and treatment of DILI in elderly patients should be taken seriously.