Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA.
Curr Gastroenterol Rep. 2021 Apr 12;23(4):6. doi: 10.1007/s11894-021-00804-7.
With its high variability in both presentation and severity, drug-induced liver injury (DILI) is a complex condition increasingly confronting all providers. DILI has an even more muddled presentation among the geriatric population due to age-related changes in liver physiology and biochemistry as well as polypharmacy common in the geriatric population.
Most cases of DILI are idiosyncratic and unpredictable. DILI, especially related to herbal and dietary supplement (HDS) use, is increasingly recognized as a leading cause of acute liver failure and need for liver transplantation. Unfortunately, liver transplantation is a limited option for the elderly, a population that exhibits significant HDS use. One recent study suggests that early use of N-acetylcysteine may be useful in preventing progression to acute liver failure in non-acetaminophen DILI. In the future, a personalized medicine approach using genomic signatures may be feasible to prevent DILI. This review serves to raise recognition of the unique aspects of DILI in the geriatric population to promote rapid diagnosis and early intervention to prevent progression to liver failure and death. For now, DILI remains a diagnosis of exclusion, and care providers for the elderly must focus on obtaining a thorough history that includes HDS use and intervening early in suspected DILI cases.
药物性肝损伤（DILI）在临床表现和严重程度上变化很大，是所有医疗服务提供者都越来越面临的复杂病症。由于老年人肝脏生理学和生物化学的变化以及老年人中常见的多种药物治疗，DILI 在老年人群中表现更为混乱。
大多数 DILI 病例是特发性和不可预测的。DILI，特别是与草药和膳食补充剂（HDS）使用有关，越来越被认为是急性肝衰竭和需要肝移植的主要原因。不幸的是，肝移植是老年人的一个有限选择，老年人 HDS 使用量很大。最近的一项研究表明，早期使用 N-乙酰半胱氨酸可能有助于预防非对乙酰氨基酚性 DILI 进展为急性肝衰竭。将来，使用基因组特征的个体化医学方法可能可以预防 DILI。本综述旨在提高对老年人中 DILI 独特方面的认识，以促进快速诊断和早期干预，防止肝衰竭和死亡的发生。目前，DILI 仍然是一种排除性诊断，老年人的医疗服务提供者必须专注于获取全面的病史，包括 HDS 的使用，并在疑似 DILI 病例中尽早干预。
