This article is more than 5 years old. Information may no longer be current.

Causes, clinical features, outcomes of drug-induced liver injury different for elderly patients

LAS VEGAS — Elderly patients with idiosyncratic drug-induced liver injury had similar severity but different causes, injury patterns and outcomes than patients aged younger than 65 years in a study presented at the 2012 American College of Gastroenterology Annual Scientific Meeting.

Researchers evaluated 1,083 patients with suspected idiosyncratic drug-induced liver injury (DILI) enrolled in the DILI Network (DILIN) Prospective Study, with follow-up for 6 months or longer. DILIN is a longstanding, NIH-funded consortium established to investigate the causes, natural history, pathogenesis and treatment of DILI, researcher Naga Chalasani, MD, director of the gastroenterology and hepatology division at Indiana University School of Medicine, told Healio.com.

Naga Chalasani

DILI was considered probable, highly likely or definite in 705 cases in the DILIN study, including 121 elderly patients and 584 aged younger than 65 years who served as the study cohort.

Severity of DILI and the distribution of causality categories were similar between elderly and nonelderly patients. DILI was more likely to be caused by antimicrobials (66% of cases vs. 42%; P<.001) or lipid-lowering agents (9% vs. 4.7%; P=.04) among the elderly, but less likely to be caused by (6.2% vs. 15.7%; P=.001) or CNS agents (2.4% vs. 10.6%; P<.001).

Patients aged older than 65 years had significantly different injury patterns than younger participants (40% hepatocellular, 35% cholestatic and 26% mixed among the elderly compared with 57% hepatocellular, 22% cholestatic and 21% mixed; P=.001). Investigators also noted that peak alanine aminotransferase levels were significantly lower among older patients (370 U/L vs. 468 U/L; P=.01), while peak alkaline phosphatase levels were higher (362 U/L vs. 267 U/L; P<.001).

No significant differences were observed between groups in the time for ALT or bilirubin levels to decrease from peak to normal ranges.

Incidence of chronic DILI was significantly less frequent among elderly patients (10% of cases compared with 20%, P=.019). Both all-cause and liver-related mortality rates were higher among older patients (9.1% vs. 5.3% for all-cause and 4.1% vs. 2.2% for liver-related), but neither difference was significant.

“DILI in the elderly appears to be caused more often by antimicrobials and less often by the CAM products and has different biochemical signature and different outcomes than in the nonelderly individuals,” the researchers concluded.

For more information:

Chalasani N. #4: Causative Agents, Clinical Features, and Outcomes of Idiosyncratic Drug Induced Liver Injury (DILI) in the Elderly: Results From the DILIN Prospective Study. Presented at: the 2012 of Gastroenterology Annual Scientific Meeting; Oct. 19-24, Las Vegas.