Clinical manifestations of elderly and non-elderly patients with drug induced liver injury

Abstract

Objective To compare and analyze the clinical characteristics of elderly and non-elderly patients with drug-induced liver injury (DILI). Methods The clinical characteristics of elderly (≥60 years old) and non-elderly (<60 years old) patients with DILI who sought medical advice in section for outpatients or hospitalized in Department of Infectious Diseases, Peking University First Hospital from January 1997 to September 2015 were analyzed retrospectively. Results The elderly group comprised 193 patients [female: 121(62.7%)] with average age of (69±7)years. The non-elderly group comprised 286 patients [female: 192(67.1%)] with average age of (43±12)years. The time from medication to the appearance of liver injury in the elderly group was 14-60 days (the median time 30 days) and the non-elderly group was 10-60 days (the median time was 30 days)(Z=-1.267, P=0.205). There were 132 cases (68.4%) with the symptoms of weakness, 121 cases (62.7%) with yellow urine, 118 cases (61.1%) of jaundice, 33 cases (17.1%) had fever in the elderly group, respectively. There were 189 cases (66.1%) with the symptoms of weakness, 182 cases (63.6%) had yellow urine, 179 cases (62.6%) had jaundice, 46 cases (16.1%) had fever in the elderly group, respectively. There were no significant differences in incidence of the symptoms mentioned above between the two groups (all P>0.05). The differences of peak values of alanine aminotransferase, alkaline phosphatase, and total bilirubin between the two groups were not statistically significant (all P>0.05). The case number of antinuclear antibody-positive in the elderly group were more than those in the non-elderly group[27(9.4%)](P<0.001). There were 221 kinds of suspected drugs which [47(24.4%)] may cause DILI in the elderly group. The top three were traditional Chinese medicine (107, 48.4%), cardiovascular agents (31, 14.0%) and antimicrobial agents (18, 8.2%). There were 316 kinds of suspected drugs which might cause DILI in the non-elderly group. The top three were traditional Chinese medicine (154, 48.7%), antimicrobial (50, 15.8%), and non-steroidal anti-inflammatory drug (23, 7.3%). The number of cases with DILI types of hepatocellular, cholestatic, and mixed in the elderly group and the non-elderly group were 157(81.4%), 13(6.7%), 23(11.9%) and 238(83.2%), 25(8.7%), 23 (8.1%), respectively. The differences were not statistically significant. The cases number of DILI classification of 1, 2, 3, 4, and 5 in the elderly group and the non-elderly group were 56(29.0%), 31(16.1%), 99(51.3%), 5(2.6%), 2(1.0%) and 65(22.7%), 37(12.9%), 174(60.9%), 4(1.4%), 6(2.1%), respectively. The differences were not statistically significant. The suspicious drugs were withdrawn and all the patients with DILI received the anti-inflammatory and hepatoprotection therapy after the appearance of clinical symptom. There were 14 cases in the elderly group and 34 cases in the non-elderly group received steroid therapy additionally. The course of disease in the elderly group were 27-78 days, the median time was 47 days. The course of disease in the non-elderly group were 30-87 days, the media time was 54 days (P=0.07). Of 193 patients in the elderly group, 176 cases (91.2%) were cured and improved, 14 cases (7.2%) developed chronic DILI, and 3 cases (1.6%) died. Of 286 patients in the non-elderly group, 254 cases (88.8%) were cured and improved, 24 cases (8.4%) developed chronic DILI, 7 cases (2.4%) died, and 1 case received liver transplantation. The difference of prognosis between the two groups were not statistically significant (P=0.856). Conclusions The traditional Chinese medicines and cardiovascular agents are the main drugs which due to DILI in elderly patients, the traditional Chinese medicines and antimicrobial are main drugs which due to DILI in non-elderly patients. In addition to the cases of accompanying with autoimmune phenomena in the elderly group are more than those in the non-elderly group, the clinical manifestations, treatment, and prognosis are similar in the elderly and non-elderly patients. Key words: Drug-induced liver injury; Aged; Disease attributes