Etiological distribution and factors influencing disease severity in elderly patients with drug-induced liver injury

Abstract

Abstract: Objective To investigate the distribution of causative drugs in elderly patients with drug-induced liver injury (DILI) and to analyze the factors associated with disease severity, as well as the histopathological characteristics of liver tissue. Methods The clinical data of 86 elderly patients with DILI treated at the No. 904 Hospital of the Joint Logistics Support Force and Qingdao Municipal Hospital were retrospectively collected and analyzed. According to the severity of the disease, patients were divided into a mild group (n=51) and a severe group (n=35). Differences in general characteristics, underlying diseases, medication status, and laboratory indicators between the two groups were compared. Liver histopathological examination was performed in 40 patients (24 in the mild group and 16 in the severe group), and the histological changes between the two groups were analyzed. Multivariate logistic regression analysis was used to identify independent risk factors associated with severe DILI in elderly patients. Results A total of 161 suspected causative drugs were identified among the 86 patients, including single-drug use in 47 cases (54.6%) and multiple-drug use in 39 cases (45.4%). Compared with the mild group, the severe group had a higher proportion of patients with malignant tumors[42.9% vs. 21.6%] and a higher proportion of multiple drug use[62.9% vs. 37.3%] (P<0.05). Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) were significantly higher in the severe group than in the mild group[ALT: 465 (266, 814) U/L vs. 214 (123, 394) U/L; AST: 398 (211, 697) U/L vs. 178 (95, 312) U/L; ALP: 212 (142, 390) U/L vs. 165 (94, 280) U/L] (P<0.05). Meanwhile, total bilirubin (TBil), international normalized ratio (INR), and serum creatinine (Scr) levels were significantly increased in the severe group[TBil: (92.5±25.7) μmol/L vs. (28.4±6.3) μmol/L; INR: (1.3±0.3) vs. (1.1±0.2); Scr: (97.8±17.6) μmol/L vs. (82.5±11.4) μmol/L], whereas albumin (Alb) levels were significantly lower[(35.6±5.3) g/L vs. (39.2±4.1) g/L] (P<0.05). Liver histopathological results showed that the scores of hepatocyte necrosis (1.7±0.5 vs. 0.9±0.3), inflammatory activity (1.9±0.7 vs. 1.1±0.4), ballooning degeneration (1.2±0.3 vs. 0.6±0.2), the degree of steatosis (19.7±5.1 vs. 14.5±3.2), and liver fibrosis (2.0±0.6 vs. 1.2±0.4) were all higher in the severe group than in the mild group (P<0.05), and the incidence of cholestasis was also significantly higher (62.5% vs. 25.0%, P<0.05). Multivariate logistic regression analysis indicated that age, malignant tumors, multiple drug use, elevated TBil, elevated INR, and increased liver fibrosis score were independent risk factors for severe DILI in elderly patients, whereas higher Alb levels were a protective factor (P<0.05). Conclusion The severity of DILI in elderly patients is closely associated with age, malignant tumors, multiple drug use, and indicators of liver function injury. Severe DILI is often characterized by more pronounced hepatocyte necrosis, inflammatory responses, and fibrosis, accompanied by cholestasis.

Key words: Drug-induced liver injury, Elderly, Disease severity, Liver histopathology, Risk factors

Liu Min, Zuo Dan, Miao Ruitian, Gao Yanfen. Etiological distribution and factors influencing disease severity in elderly patients with drug-induced liver injury[J]. Chinese Hepatolgy, 2026, 31(6): 891-895.

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