中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 7
Jul.  2021
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(7): 1626-1631

Clinical features of elderly patients with drug-induced liver failure: An analysis of 65 cases

DOI: 10.3969/j.issn.1001-5256.2021.07.029
  • 1.

    Department of Hepatology of Traditional Chinese Medicine, The Fifth Medical Center of PLA General Hospital, Beijing 100039, China

  • 2.

    Department of Hepatology and Spleen-Stomach, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450000, China

  • Received Date: 2020-10-06
  • Accepted Date: 2021-01-15
  • Published Date: 2021-07-20
    Abstract
  •   Objective  To investigate the features and medication of elderly patients with drug-induced liver failure (DILF), and to provide a reference for clinical prevention and treatment of DILF in elderly patients.  Methods  A total of 65 elderly patients, aged ≥60 years, who were diagnosed with DILF in The Fifth Medical Center of Chinese PLA General Hospital from January 2015 to December 2019 were enrolled and divided into groups based on the criteria for clinical outcome evaluation. The patients who were cured or improved were enrolled as response group, and those who had no response or died were enrolled as non-response group. Related clinical data were collected and analyzed, including age, sex, underlying diseases, type of the drug used, clinical classification, complications, and prognosis. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups.  Results  Among the 65 elderly patients with DILF, there were 17 male patients (26.2%) and 48 female patients (73.8%), with a male/female ratio of 1∶ 2.82. Subacute liver failure (SALF) was the main type of DILF in the elderly patients (81.5%), and cholestasis type was the most common clinical type (40%). There were 26 patients in the response group and 39 in the non-response group, accounting for 40% and 60%, respectively, of all patients. As for complications, compared with the non-response group, the response group had a significantly higher proportion of patients with pleuroperitoneal fluid (61.5% vs 28.2%, P < 0.05), a significantly lower proportion of patients with hepatorenal syndrome (19.2% vs 56.4%, P < 0.05), a significantly higher proportion of patients without hepatic encephalopathy (80.8% vs 30.8%, P < 0.05), and a significantly lower proportion of patients with stage 4 hepatic encephalopathy (0 vs 20.5%, P < 0.05). The main drugs causing DILF included cardiovascular and cerebrovascular drugs (10.8%), antihypertensive drugs (9.2%), and antibiotics (7.7%); traditional Chinese medicine drugs were mainly Chinese patent drugs (35.4%) and Chinese herbal medicine (23.1%); healthcare product was the most common type of biological products (20.0%).  Conclusion  SALF is the most common type of DILF in the elderly, and cholestasis type is the main clinical type of DILF. Patients with hepatic encephalopathy and hepatorenal syndrome tend to have poor prognosis.

     

    • FullText(HTML)
  • loading
    • References(25)
  • [1]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
    [2]
    LIU FF, WU JY, ZHANG HY, et al. Clinical characteristics of patients with hepatitis B-induced acute-on-chronic liver failure and the effects of plasma exchanges on their prognosis[J]. J Prac Hepatol, 2016, 19(2): 188-191. DOI: 10.3969/j.issn.1672-5069.2016.02.016.

    刘菲菲, 吴吉圆, 张海月, 等. 慢加急性乙型肝炎肝衰竭临床特征及血浆置换治疗对其预后的影响[J]. 实用肝脏病杂志, 2016, 19(2): 188-191. DOI: 10.3969/j.issn.1672-5069.2016.02.016.
    [3]
    FAN ZP, NIE W, LIANG S, et al. Clinical characteristics of patients with drug-induced liver failure in Beijing[J]. Beijing Med J, 2015, 37(9): 846-849. DOI: 10.15932/j.0253-9713.2015.9.009.

    范作鹏, 聂巍, 梁珊, 等. 北京地区药物性肝衰竭临床特点分析[J]. 北京医学, 2015, 37(9): 846-849. DOI: 10.15932/j.0253-9713.2015.9.009.
    [4]
    RASCHI E, DE PONTI F. Drug-induced liver injury: Towards early prediction and risk stratification[J]. World J Hepatol, 2017, 9(1): 30-37. DOI: 10.4254/wjh.v9.i1.30.
    [5]
    Drug-induced Liver Disease Study Group, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the management of drug-induced liver injury[J]. J Clin Hepatol, 2015, 31(11): 1752-1769. DOI: 10.3969/j.issn.1001-5256.2015.11.002.

    中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南[J]. 临床肝胆病杂志, 2015, 31(11): 1752-1769. DOI: 10.3969/j.issn.1001-5256.2015.11.002.
    [6]
    DANAN G, BENICHOU C. Causality assessment of adverse reactions to drugs—I. A novel method based on the conclusions of international consensus meetings: Application to drug-induced liver injuries[J]. J Clin Epidemiol, 1993, 46(11): 1323-1330. DOI: 10.1016/0895-4356(93)90101-6.
    [7]
    Branch of Hepatobiliary Diseases, China Association of Chinese Medicine, Branch of Chinese Patent Medicine, China Association of Chinese Medicine. Guidelines for the clinical management of herb-induced liver injury[J]. J Clin Hepatol, 2016, 32(5): 835-843. DOI: 10.3969/j.issn.1001-5256.2016.05.003.

    中华中医药学会肝胆病分会, 中华中医药学会中成药分会. 中草药相关肝损伤临床诊疗指南[J]. 临床肝胆病杂志, 2016, 32(5): 835-843. DOI: 10.3969/j.issn.1001-5256.2016.05.003.
    [8]
    YANG FJ, PENG L, GAO ZL. New strategies and advances on diagnosis and treatment of patients with HBV related acute-on-chronic liver failure[J]. Chin J Clin Infect Dis, 2017, 10(2): 101-106. DOI: 10.3760/cma.j.issn.1674-2397.2017.02.004.

    杨方集, 彭亮, 高志良. 乙型肝炎慢加急性肝衰竭诊疗的新策略与新进展[J]. 中华临床感染病杂志, 2017, 10(2): 101-106. DOI: 10.3760/cma.j.issn.1674-2397.2017.02.004.
    [9]
    LIU XY, HU JH, WANG HF, et al. Etiological analysis of 1977 patients with acute liver failure, subacute liver failure and acute-on-chronic liver failure[J]. Chin J Hepatol, 2008, 16(10): 772-775. DOI: 10.3321/j.issn:1007-3418.2008.10.013.

    刘晓燕, 胡瑾华, 王慧芬, 等. 1977例急性、亚急性、慢加急性肝衰竭患者的病因与转归分析[J]. 中华肝脏病杂志, 2008, 16(10): 772-775. DOI: 10.3321/j.issn:1007-3418.2008.10.013.
    [10]
    GALVIN Z, McDONOUGH A, RYAN J, et al. Blood alanine aminotransferase levels > 1, 000 IU/l - causes and outcomes[J]. Clin Med (Lond), 2015, 15(3): 244-247. DOI: 10.7861/clinmedicine.15-3-244.
    [11]
    GOLDBERG DS, FORDE KA, CARBONARI DM, et al. Population-representative incidence of drug-induced acute liver failure based on an analysis of an integrated health care system[J]. Gastroenterology, 2015, 148(7): 1353-1361. DOI: 10.1053/j.gastro.2015.02.050.
    [12]
    ZHU Y, LI YG, WANG N, et al. Analysis of clinical characteristics in 595 patients with herb-induced liver injury[J]. Chin J Integr Trad West Med, 2016, 36(1): 44-48. DOI: 10.7661/CJIM.2016.01.0044.

    朱云, 李永纲, 王葽, 等. 595例中药导致肝损伤临床特征分析[J]. 中国中西医结合杂志, 2016, 36(1): 44-48. DOI: 10.7661/CJIM.2016.01.0044.
    [13]
    ZIMMERMAN HJ. Drug-induced liver disease[J]. Clin Liver Dis, 2000, 4(1): 73-96, vi. DOI: 10.1016/s1089-3261(05)70097-0.
    [14]
    LU RJ, ZHU SM, TANG FL, et al. Clinical characteristics and risk factors of 424 cases of drug-induced liver injury[J]. Chin Hepatol, 2017, 22(3): 235-239. DOI: 10.3969/j.issn.1008-1704.2017.03.014.

    陆人杰, 朱珊梅, 唐风雷, 等. 424例药物性肝损伤临床特征及相关危险因素分析[J]. 肝脏, 2017, 22(3): 235-239. DOI: 10.3969/j.issn.1008-1704.2017.03.014.
    [15]
    LI YY, GENG H, YU SJ, et al. Clinical study of neutrophil-lymphocyte ratio and disease progression in patients with HBV-related acute-on-chronic liver failure[J]. Chin J Gastroenterol Hepatol, 2016, 25(4): 411-414. DOI: 10.3969/j.issn.1006-5709.2016.04.013.

    李元元, 耿华, 于双杰, 等. 中性粒细胞与淋巴细胞比值与乙型肝炎相关性慢加急性肝衰竭疾病进展的临床研究[J]. 胃肠病学和肝病学杂志, 2016, 25(4): 411-414. DOI: 10.3969/j.issn.1006-5709.2016.04.013.
    [16]
    TENG GJ, ZHANG W, SUN Y, et al. Clinical features and prognosis of 141 patients with drug-induced liver failure[J]. Infect Dis Info, 2011, 24(5): 286-289. DOI: 10.3969/j.issn.1007-8134.2011.05.008.

    滕光菊, 张伟, 孙颖, 等. 141例药物性肝衰竭临床特征及预后分析[J]. 传染病信息, 2011, 24(5): 286-289. DOI: 10.3969/j.issn.1007-8134.2011.05.008.
    [17]
    LEE WM. Drug-induced acute liver failure[J]. Clin Liver Dis, 2013, 17(4): 575-586, viii. DOI: 10.1016/j.cld.2013.07.001.
    [18]
    LIU XY, CHEN J, WANG XX, et al. Etiological analysis of 3233 patients with acute liver failure, subacute liver failure and acute-on-chronic liver failure[J]. Clin Med Eng, 2012, 19(5): 823-825. DOI: 10.3969/j.issn.1674-4659.2012.05.0823.

    刘晓燕, 陈婧, 王晓霞, 等. 3233例急性、亚急性、慢加急性肝衰竭病因特点分析[J]. 临床医学工程, 2012, 19(5): 823-825. DOI: 10.3969/j.issn.1674-4659.2012.05.0823.
    [19]
    FAN ZP, NIE W, LIANG S, et al. Clinical characteristics of patients with drug-induced liver failure in Beijing[J]. Beijing Med J, 2015, 37(9): 846-849. DOI: 10.15932/j.0253-9713.2015.9.009.

    范作鹏, 聂巍, 梁珊, 等. 北京地区药物性肝衰竭临床特点分析[J]. 北京医学, 2015, 37(9): 846-849. DOI: 10.15932/j.0253-9713.2015.9.009.
    [20]
    LI J, ZHANG YL, ZHANG WL, et al. Analysis of etiology and prognosis of 229 cases of liver failure[J]. Chin Hepatol, 2016, 21(4): 276-279. DOI: 10.3969/j.issn.1008-1704.2016.04.009.

    李娟, 张云丽, 张文丽, 等. 229例肝功能衰竭病因与转归分析[J]. 肝脏, 2016, 21(4): 276-279. DOI: 10.3969/j.issn.1008-1704.2016.04.009.
    [21]
    HAN L, YANG Z, LIANG QS, et al. Clinical features of 100 patients with drug-induced liver failure[J]. Chin Hepatol, 2019, 24(3): 229-233. DOI: 10.3969/j.issn.1008-1704.2019.03.007.

    韩琳, 杨曌, 梁庆升, 等. 药物性肝衰竭100例临床特征分析[J]. 肝脏, 2019, 24(3): 229-233. DOI: 10.3969/j.issn.1008-1704.2019.03.007.
    [22]
    DEVARBHAVI H, PATIL M, REDDY VV, et al. Drug-induced acute liver failure in children and adults: Results of a single-centre study of 128 patients[J]. Liver Int, 2018, 38(7): 1322-1329. DOI: 10.1111/liv.13662.
    [23]
    SINGH S, HYNAN LS, LEE WM, et al. Improvements in hepatic serological biomarkers are associated with clinical benefit of intravenous N-acetylcysteine in early stage non-acetaminophen acute liver failure[J]. Dig Dis Sci, 2013, 58(5): 1397-1402. DOI: 10.1007/s10620-012-2512-x.
    [24]
    FONTANA RJ, HAYASHI PH, GU J, et al. Idiosyncratic drug-induced liver injury is associated with substantial morbidity and mortality within 6 months from onset[J]. Gastroenterology, 2014, 147(1): 96-108. DOI: 10.1053/j.gastro.2014.03.045.
    [25]
    DUAN Y, XING HC, WANG XM, et al. Clinical characteristics and prognosis of drug-induced subacute liver failure[J/CD]. Chin J Exp Clin Infect Dis (Electronic Edition), 2012, 6(3): 217-220. DOI: 10.3877/cma.j.issn.1674-1358.2012.03.010.

    段英, 邢卉春, 王笑梅, 等. 药物性亚急性肝衰竭临床特点及预后[J/CD]. 中华实验和临床感染病杂志(电子版), 2012, 6(3): 217-220. DOI: 10.3877/cma.j.issn.1674-1358.2012.03.010.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (486) PDF downloads(48) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return