Analysis Of 86 Cases Drug-induced Liver Injury In Elderly And Evaluation Of Prognostic Factors

[Background]Drug-induced liver injury is showing a growing incidence and has become a major cause of chronic liver disease. DILI incidence differs in different countries and regions, and currently the epidemiology record in China is insufficient, especially there has not been enough information on DILI cases in the elderly, however the aging of population is a problem calling for attention. The survey aims to analyze the clinical characteristics of elderly DILI patients in our hospital and relevant factors.[Aims]1. To implement a retrospective analysis of DILI patients with the first diagnosis being DILI and aged more than 60 in Huadong Hospital, with the purpose to explore the etiology, clinical features, diagnostic criteria and prognostic factors, to foster awareness, quick identification of the disease and improve prognosis.2. To form a comprehensive analysis of the major involvement of the elderly DILI drugs, the risk of concomitant medication, medication time, duration, gender distribution, clinical characteristics, variation of all clinical features and various clinical indicators, for further discussion of the disease characteristics of DILI in the elderly.3. To observe the clinical parameters and the relationship between various types of liver damage and related factors, according to the comparison and statistical processing of different DILI types.4. To form a comprehensive analysis of the patient’s prognosis situation, and analyze the types of medication, concomitant medication, gender, clinical type, concomitant diseases, and the onset biochemical effects on prognosis, on the basis of prognostic classification and statistical processing. To provide possible reference for clinical treatment of the disease in elderly patients, liver damage caused by certain medication in future diagnosis and treatment.[Methods]A retrospective analysis of 86 DILI patients in hospital during 2000-2012 with first diagnosis being DILI was implemented, and data including the patients’gender, occupation, medication that caused liver damage, concomitant medication, clinical features, laboratory tests, concomitant diseases, allergies and prognosis was collected, thus clinical characteristics of DILI in elderly can be observed.[Results]1. This study was carried on a group of patients totaled 86, including 37 male patients and 49 female patients, gender ratio being 1:1.32, age between 60-89 years, mean age 73.98 ± 7.67 years old. According to the types of DILI,39 of liver cell damage,32 of cholestasis,5 of mixed liver injury,10 of abnormal liver function 10.2. There are two types of medicine causing DILI:Chinese herbal medicine mainly (31.4%), followed by antibiotics (10.5%), hormones (10.5%), lipid-lowering statin drugs (9.3%), other types of drugs including chemotherapy drugs also, hypoglycemic agents, neuropsychiatric class, NSAID, etc., with the most frequently seen concomitant medication being cardiovascular, antibiotics and health products.3. DILI are mainly caused by underlying diseases such like hypertension (36.6%), type 2 diabetes (16.1%), and also cholecystitis, cholelithiasis, hyperlipidemia, coronary heart disease, arrhythmia, cerebral infarction and chronic renal insufficiency.4. Clinical manifestations:specificity is not obvious, the most common first symptom is anorexia (21.5%), other manifestations being fatigue (14%), dark urine (19.4%), jaundice (15%), abdominal discomfort (bloating, abdominal pain) (12.9%), diarrhea (1.1%), weight loss (1.1%), plus 15.1% of the patients without showing discomfort, whose abnormal liver functions were discovered during physical tests. Extrahepatic manifestations include 4 people with fever (4.7%),8 with rash or pruritus (9.3%). The shortest time from taking medication causing liver damage to symptoms being found is two days, longest time six years, median time 30 days. The shortest time from stopping taking medication causing liver damage to symptoms recovered is 3 days, longest time 270 days, and median time 15 days. The average duration of DILI is 19.5±39.3 days.5. Laboratory tests:specificity is not obvious. Elderly patients of DILI with abnormal laboratory test results show following frequency:ALT 98.8%, AST 92.8%, ALP 55.1%, GGT 83.5%, TBIL 51.3%, IBIL 64.5%, DBIL 39.5%. Therefore, the above indicators show comparatively higher sensitivity, liver damage can be diagnosed by examining these laboratory markers, but these indicators have low specificity for the diagnosis of DILI. In addition, the elevation range of ALT, AST, ALP and GGT are located within 10 ULN.6.6 Treatment and prognosis:after the diagnosis of drug-induced liver injury was made, the patients stopped taking medication causing liver damage drugs and were all given conservative treatment, medicine given include polyene phosphatidylcholine, glutathione and licorice diammonium and other liver-protecting drugs,37 people were healed,46 people got better and 2 people died.7. The differences of ALT, AST, ALP and GGT from 4 types of DILI were statistically significant, compared with cholestasis and mixed typed liver damage, ALT, AST of liver cell damage type increased (P<0.01), while ALP, GGT were higher in the cholestasis type(P<0.01).8. The analysis of laboratory parameters, gender, clinical classification, concomitant diseases and prognosis showed that onset AST, GGT, etc. can be good prediction of DILI in the elderly. Bilirubin levels increase significantly with the growing age and TBIL, IBIL, DBIL all increase to various degrees, with a statistically difference. Triglyceride levels of elderly patients with DILI differ with gender, males patients higher than female patients. It is quite common that elderly patients with DILI take concomitant medication, the types of medication increase with age, the levels of starting AST and eosinophils rise in most concomitant medication, with a statistically significant difference.[Conclusion]This study has concluded the following characteristics of DILI in the elderly:there is a wide variety of medicine causing liver damage and the largest proportion is Chinese herbal medicine, followed by antibiotics and hormones, the most frequently used concomitant medication includes cardiovascular medication, antibiotics and health commodities; elderly patients tend to bring a series of underlying diseases, therefore the use of concomitant medication is becoming more and more common with the growing age, causing the levels of AST and eosinophils to increase obviously, showing a significant statistical difference. The first test of AST, GGT on admission can be used to predict the prognosis of the disease. The clinical manifestations and laboratory tests are nonspecific, elevation of liver function is generally within the range of 10ULN, DILI in the elderly shows ideal prognosis and the most common type is cholestatic.