Editor’s Note: In recent years, with the increase in health awareness, the incidence of drug-induced liver injury (DILI) has been rising. Immune responses can trigger inflammation and necrosis, leading to liver fibrosis, which affects prognosis. The elderly, a high-risk group for DILI, require more attention, but there is limited research on their disease characteristics and prognosis. Therefore, identifying the clinical features of elderly DILI patients and actively preventing them is an effective way to improve disease prognosis and patient quality of life. At the 32nd APASL Annual Conference, the team led by Professor Ji Dong from the Fifth Medical Center of the PLA General Hospital in China presented a study that retrospectively analyzed the clinical characteristics of elderly DILI patients with autoimmune phenomena.
Background
DILI is a severe potential adverse drug event, with its incidence increasing yearly. Due to the lack of clear etiology, specific clinical manifestations, and diagnostic methods, predicting and treating DILI is challenging. DILI combined with autoimmune phenomena is an important category of drug-induced liver toxicity, highlighting the critical role of autoimmune responses in the progression of DILI. Moreover, the elderly often have underlying diseases and take multiple medications, which may alter drug-induced immune and inflammatory responses.
Therefore, clarifying the clinical characteristics of elderly DILI patients with autoimmune phenomena helps in early treatment selection, delaying liver fibrosis progression, and improving prognosis.
Method
This retrospective study included elderly (≥60 years) DILI patients diagnosed via liver biopsy at the Fifth Medical Center of the PLA General Hospital in China from January 2012 to September 2022. Based on histological immune characteristics, the patients were divided into groups without autoimmune phenomena, with autoimmune phenomena (defined as having autoimmune phenomena but not meeting the pathological diagnosis criteria for autoimmune hepatitis, such as hepatocytes showing “rosette” changes, portal and lobular inflammation, plasma cell infiltration, or interface hepatitis), and autoimmune hepatitis (AIH, defined as meeting the pathological diagnosis criteria for AIH). Patient characteristics were collected for trend analysis.
Results
A total of 380 elderly DILI patients were included, with a median age of 63.3 years (IQR, 61.0-66.0), predominantly female (73.7%) and cholestatic (46.8%). In the groups without autoimmune phenomena (65.8%), with autoimmune phenomena (26.3%), and AIH (7.9%), the proportions of IgG≥1.1×ULN were 9.6%, 25.0%, and 46.7%, respectively; the positivity rates for autoantibodies (ANA or SMA) were 29.2%, 48.0%, and 73.3%, respectively; and the proportions of significant liver fibrosis (≥S2) were 54.0%, 59.0%, and 90.0%, respectively, with a statistically significant trend (P<0.05).
Conclusion
The study results indicate that elderly DILI patients are more likely to exhibit histological features of autoimmunity, and the presence of autoimmunity can promote the progression of liver fibrosis.
Due to abnormal drug metabolism kinetics, aging tissue repair functions, comorbidities, and polypharmacy, the elderly are considered a high-risk group for DILI. Studies have shown that comorbidities and polypharmacy are associated with increased non-liver-related mortality in elderly DILI patients. Therefore, clinicians should be cautious when prescribing for the elderly and more actively follow up and treat elderly DILI patients with autoimmune phenomena.
TAG: APASL 2023, Voice of China, DILI
