期刊
CLINICAL PHARMACOLOGY & THERAPEUTICS
卷 109, 期 4, 页码 1147-1158出版社
WILEY
DOI: 10.1002/cpt.2108
关键词
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资金
- Instituto de Salud Carlos III (ISCIII) [PI 18/01804, PT17/0017/0020]
- Agencia Espanola del Medicamento
- ISCIII
- National Health System, ISCIII [CM17/00243, JR16/00015]
- University of Malaga
Older patients with DILI show higher comorbidity burden and polypharmacy, with a more severe liver injury characterized by cholestatic phenotype. Additionally, they have increased non-liver-related mortality, suggesting a different approach is needed to predict outcomes for this population.
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.
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