There are limited studies regarding older patients with hepatotoxicity in idiosyncratic drug-induced liver injury (DILI) cohorts. The authors of the current study identified the distinctive characteristics of DILI in older patients across age groups. They recruited a total of 882 DILI patients in the DILI Registry (33% ≥ 65 years) and the patients 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 included in the study had an increasingly higher comorbidity burden and polypharmacy. 

The results showed an existence of association between jaundice and hospitalization, both of which were prevalent in the older age groups, particularly in the oldest-old (88% and 69%, respectively). These factors resulted in increased severity of DILI episode. Although the proportion of females reduced across age groups from the young to the middle-old, female predominance was seen in the oldest-old. The patients showed cholestatic type of liver injury with increasing incidence with higher age and the main drugs implicated in the injury included amoxicillin-clavulanate, atorvastatin, levofloxacin, ibuprofen, and ticlopidine. The best cutoff point for increased odds of cholestatic DILI was 65 years. Non-liver-related mortality was seen in older patients as shown by the predictive capacity of the Model for End-Stage Liver Disease score (odds ratio (OR) = 1.116) and comorbidity burden (OR = 4.188) in the 6-month mortality. 

Thus, it can be summarized that predominance of cholestatic phenotype injury is more prevalent in older patients with DILI. This pattern of hepatotoxicity can be seen across a range of offending drugs, other than amoxicillin-clavulanate. These drugs are also associated with increased non-liver-related mortality and hence, warrants an altered approach to predict prognosis. Moreover, the oldest DILI patients are more susceptible to the phenotype leading to more severe DILI episodes, which further should be assessed when stratifying older DILI populations.

Source: Clinical Characteristics and Outcome of Drug-Induced Liver Injury in the Older Patients: From the Young-Old to the Oldest-Old. Clin Pharmacol Ther. 2020 Nov 11.