Artículo
Clinical characteristics and outcome of drug-induced liver injury in the older patients: from the young-old to the oldest-old
Autor/es | Weersink, Rianne A.
Alvarez-Alvarez, Ismael Medina-Cáliz, Inmaculada Romero Gómez, Manuel Ampuero Herrojo, Javier Rodríguez Seguel, Elisa del Pilar Cuevas, L. |
Departamento | Universidad de Sevilla. Departamento de Medicina Universidad de Sevilla. Departamento de Biología Celular |
Fecha de publicación | 2021 |
Fecha de depósito | 2022-10-27 |
Publicado en |
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Resumen | Older patients with hepatotoxicity have been scarcely studied in idiosyncratic drug-induced liver injury (DILI) cohorts. We sought the distinctive characteristics of DILI in older patients across age groups. A total of 882 ... Older patients with hepatotoxicity have been scarcely studied in idiosyncratic drug-induced liver injury (DILI) cohorts. We sought the distinctive characteristics of DILI in older patients across age groups. A total of 882 DILI patients included in the Spanish DILI Registry (33% ≥ 65 years) were categorized according to age: “young” (< 65 years); “young-old” (65–74 years); “middle-old” (75–84 years); and “oldest-old” (≥ 85 years). All elderly groups had an increasingly higher comorbidity burden (P < 0.001) and polypharmacy (P < 0.001). There was a relationship between jaundice and hospitalization (P < 0.001), and both were more prevalent in the older age groups, especially in the oldest-old (88% and 69%, respectively), and the DILI episode was more severe (P = 0.029). The proportion of females decreased across age groups from the young to the middle-old, yet in the oldest-old there was a distinct female predominance. Pattern of liver injury shifted towards cholestatic with increasing age among top culprit drugs amoxicillin-clavulanate, atorvastatin, levofloxacin, ibuprofen, and ticlopidine. The best cutoff point for increased odds of cholestatic DILI was 65 years. Older patients had increased non–liver-related mortality (P = 0.030) as shown by the predictive capacity of the Model for End-Stage Liver Disease score (odds ratio (OR) = 1.116; P < 0.001), and comorbidity burden (OR = 4.188; P = 0.001) in the 6-month mortality. Older patients with DILI exhibited an increasingly predominant cholestatic phenotype across a range of culprit drugs, other than amoxicillin-clavulanate, with increased non–liver-related mortality and require a different approach to predict outcome. The oldest DILI patients exhibited a particular phenotype with more severe DILI episodes and need to be considered when stratifying older DILI populations. |
Cita | Weersink, R.A., Alvarez-Alvarez, I., Medina-Cáliz, I., Romero Gómez, M., Ampuero Herrojo, J., Rodríguez Seguel, E.d.P. y Cuevas, L. (2021). Clinical characteristics and outcome of drug-induced liver injury in the older patients: from the young-old to the oldest-old. Clinical Pharmacology & Therapeutics, 109 (4), 1147-1158. https://doi.org/10.1002/cpt.2108. |