Relationship between voriconazole trough concentration and liver injury in elderly patients with lung invasive aspergillosis

Objective To investigate the relationship between voriconazole trough concentration and liver injury in elderly patients with lung invasive aspergillosis. Methods The clinical data of patients receiving voriconazole therapeutic drug monitoring matched with the inclusion criteria, who admitted to our hospital from 1 January, 2018 to 30 June, 2019 were retrospectively analyzed. Patients were divided into elderly group (≥60 years) and adult group (≥18~ < 60 years) according to age. The route of administration, daily voriconazole dose, voriconazole trough concentration, and liver injury of patients were compared between the two groups. Results A total of 179 patients with lung invasive aspergillosis were included in, with 329 voriconazole trough concentration. There were 87 patients in elderly group, with 131 voriconazole trough concentration. There were 92 patients in elderly group, with 198 voriconazole trough concentration. Most patients in the elderly group received an intravenous drip, which was higher than that in adult group (P < 0.01). The voriconazole dosing was similar in the two cohorts (P > 0.05). The voriconazole trough concentration in elderly group was 3.86 (2.02, 6.00) μg/mL, which was higher than 2.6 (1.5, 4.0)μg/mL in adult group (P < 0.01). The proportion of voriconazole trough concentrations higher than 5 μg/mL in the elderly group was higher than that in the adult group (P < 0.01). The incidence rate of alanine aminotransferase (ALT) increasing in elderly group was lower than that in the adult group (P < 0.01). The incidence rate of albumin decreasing in elderly group was higher than that in the adult group (P < 0.01). The incidence of increased alkaline phosphatase (ALP), ALT, and gamma-glutamyl transpeptidase (GGT) concentrations and decreased albumin level was higher in the elderly group than that in the adult group when the voriconazole trough concentration was higher than 5 μg/mL (P < 0.05). There were no correlations of voriconazole trough concentration with ALP, ALT, aspartate aminotransferase (AST), GGT, total bilirubin, and albumin in elderly group (r=0.018, 0.154, 0.166, -0.171, -0.138, -0.118, P > 0.05). There were positive correlation of voriconazole trough concentration with AST and total bilirubin in adult group (r=0.267, 0.618, P < 0.01). There was negative correlation between voriconazole trough concentration and albumin in adult group (r=-0.214, P < 0.05). Conclusion The voriconazole trough concentration in elderly patients was higher than that in adult patients; the elderly patients have the high incidence of liver injury when the voriconazole trough concentration was higher than 5 μg/mL; there were no correlations of voriconazole trough concentration and liver function indexes in elderly patients.