title: Prospective surveillance of acute serious liver disease unrelated to infectious, obstructive, or metabolic diseases: epidemiological and clinical features, and exposure to drugs.
abstract: OBJECTIVE
  Acute serious liver disease which is unrelated to infectious, obstructive, or metabolic disease is uncommon. Many drugs have been implicated. Data on its epidemiology are scarce. We performed a population-based prospective study of acute serious liver disease in Catalonia (Spain).
  
  
  METHODS
  A collaborating hospital network was set up. All patients with acute serious liver disease and negative viral hepatitis serological markers, without an obvious cause of liver disease, were included.
  
  
  RESULTS
  The incidence of acute serious liver disease was 7.4 per 10(6) inhabitants per year (95% CI; 6.0-8.8), which increased with age. The incidence of hepatocellular acute serious liver disease (3.84 per 10(6) per year) was greater than that of cholestatic and mixed patterns. The case-fatality ratio was 11.9% and mortality 0.8 per million person-years. The risk of death was similar among patients with hepatocellular and cholestatic patterns. Non-steroidal antiinflammatory drugs, analgesics, and antibacterials were the most frequently used drugs.
  
  
  CONCLUSIONS
  Acute serious liver disease which is unrelated to infectious, obstructive, or metabolic disease is rare. Its incidence increases with age. The prognosis of cholestatic acute serious liver disease does not significantly differ from that of the hepatocellular pattern. Non-steroidal antiinflammatory drugs, analgesics, and antibacterials were the most common drugs likely to be responsible for acute liver disease.
authors.affiliation: Fundació Institut Català de Farmacologia, Barcelona, Spain. li@icf.uab.es
authors.forename: Luisa
authors.initials: L
authors.lastname: Ibáñez
authors.forename: Eulàlia
authors.initials: E
authors.lastname: Pérez
authors.forename: Xavier
authors.initials: X
authors.lastname: Vidal
authors.forename: Joan Ramon
authors.initials: JR
authors.lastname: Laporte
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000401:mortality; D002780:Cholestasis, Intrahepatic / Q000209:etiology / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000209:etiology / Q000401:mortality*; D017114:Liver Failure, Acute / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis