Guo Tiantian, Ma Zikun, Wang Yu, Wu Ting, Wang Yan, Li Kexin, Ou Xiaojuan, Jia Jidong, Zhao Xinyan
Objective To explore the clinical characteristics and prognosis of drug-induced liver injury (DILI) in elderly patients. Methods The clinical data (including demographic characteristics, clinical features and relevant laboratory tests, suspected pathogenic drugs, and prognosis of DILI, etc.) of patients hospitalized due to DILI from January 2009 to December 2020 were collected through the DILI Data- base in Liver Research Center of Beijing Friendship Hospital, Capital Medical University. The patients were divided into young group (<40 years old), middle-aged group (40-59 years old), and elderly group (≥ 60 years old) according to their ages. The demographic characteristics, clinical features, and prognosis of DILI were compared among the 3 groups. The risk factors for all-cause death/liver transplantation in DILI patients were analyzed using univariate and multivariate COX regression models. Results A total of 620 patients were entered in the study, including 477 females (76.9%) and 143 males (23.1%), with a median age of 56 (46, 64) years. There were 101 patients (16.3%) in the young group, 273 (44.0%) in the middle-aged group, and 246 (39.7%) in the elderly group, respectively. Compared with the young and middle-aged group respectively, patients in the elderly group had less fever [5.7% (14/246) vs. 18.8% (19/101) and 11.4% (31/273)], more abdominal distension [26.8% (66/246) vs. 11.9% (12/101) and 18.7% (51/273)], higher levels of alkaline phosphatase [171 (127, 265) U/L vs. 146 (104, 218) U/L and 158 (114, 221) U/L], gamma-glutamyltransferase [211 (132, 361) U/L vs. 122 (67, 200) U/L and 167 (94, 291) U/L], and serum creatinine [70 (59, 81) μmol/L vs. 58 (49, 72) μmol/L and 63 (57, 71) μmol/L], lower levels of serum albumin [36.2 (32.0, 38.8) g/L vs. 38.4 (35.2, 41.3) g/L and 37.3 (34.1, 40.7) g/L], immunoglobulin M [840 (610, 1190) mg/L vs. 1-030 (820, 1-460) mg/L and 1-060 (700, 1-480) mg/L], and platelet counts [186 (143, 236)×109/L vs. 214 (174, 270)×109/L and 210 (160, 257)×109/L], higher proportion of cholestasis type [13.0% (32/246) vs. 3.0% (3/101) and 5.5% (15/273)], lower rate of normalized liver function [80.5% (198/246) vs. 88.1% (89/101) and 89.0% (243/273)], and higher proportion of all-cause death/liver transplantation [5.7% (14/246) vs. 3.0% (3/101) and 1.5% (4/273)]. The differences above mentioned were statistically significant (all P<0.05). Multivariate COX regression analysis showed that age [hazard ratio (HR)=1.029, 95% confidence interval (CI): 1.002-1.056, P=0.034), serum albumin (HR=0.933, 95%CI: 0.883-0.985, P=0.012), cholesterol (HR=1.006, 95%CI: 1.004-1.008, P<0.001), serum creatinine (HR=1.007, 95%CI: 1.000-1.015, P=0.049), and severity of DILI (HR=2.328, 95%CI: 1.692-3.202, P<0.001) were independent influencing factors of all-cause death/liver transplantation in DILI patients. Conclusions Age, serum albumin, total cholesterol, serum creatinine, and severity of DILI are independent influencing factors for all-cause death/liver transplantation in DILI. Cholestatic liver injury is more common in elderly patients with DILI and the prognosis is poor, which needs more clinical attention.