Abstract: Objective This study was conducted to summarize clinical feature of elderly patients with drug-induced liver injury (DILI), and to investigate risk factors impacting severity of liver illness. Methods 181 elderly patients with various underlying diseases were encountered in our hospital between December 2018 and February 2024, and DILI was routinely diagnosed, catalogued and liver injury determined. Univariate and multivariate Logistic regression analysis was applied to find risk factors for liver injuries. Results Of 181 elderly patients, DILI was diagnosed in 44 cases(24.3%), including hepatocellular injury in 28 cases, cholestasis in 12 cases and mixed type in 4 cases; there were mild liver injury in 25 cases, moderate in 10 cases, severe in 8 cases and dead in 1 cases; suspected herbal medicines accounted for 27.3%, health care agents for 22.7%, agents for endocrine diseases for 13.6% and medicines for cardiovascular diseases for 11.4%, etc; ages in patients with DILI was 72(66, 76)yr, much greater than [67(65, 69)yr, P<0.05] in patients without DILI, percentages of multiple concurrent underlying diseases, alcohol abuse, fatty liver and hyperlipidemia were 79.6%, 27.3%, 56.8% and 84.1%, all much higher than 11.7%, 3.6%, 12.4% and 8.7% (all P<0.05) in patients without DILI; ages in 9 patients with liver injury grade 3 or more was 73(67, 75) yr, much older than [67(66, 70)yr, P<0.05] in 35 patients with liver injury of grade 2 or less, percentages of ethanol intake, multiple underlying diseases and concurrent fatty liver was 88.9%, 100.0% and 88.9%, all significantly greater than 11.4%, 74.3% and 48.6% (all P<0.05) in patients with grade 2 or less liver injuries; multivariate Logistic regression analysis showed that elderly [OR:1.67, 95%CI:1.26-3.05], alcohol abuse [OR:2.43, 95%CI:1.35-3.17] and fatty liver [OR:2.14, 95%CI:1.50-4.75] were all the risk factors impacting severity of liver injuries in elderly patients with DILI(P<0.05). Conclusion Herbal medicine, health care drugs, agents for endocrine and cardiovascular diseases could lead to DILI occurrence in elderly patients with multiple system diseases, in which drug-drug interactions might involve in this setting, and clinicians should carefully deal with underlying diseases, and prescribe medicines as necessary as possible.

Key words: Drug-induced liver injury, Underlying diseases, Clinical feature, Risk factors, Elderly