Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period.
OBJECTIVE
Progress in the understanding of susceptibility factors to drug-induced liver injury (DILI) and outcome predictability are hampered by the lack of systematic programs to detect bona fide cases.


METHODS
A cooperative network was created in 1994 in Spain to identify all suspicions of DILI following a prospective structured report form. The liver damage was characterized according to hepatocellular, cholestatic, and mixed laboratory criteria and to histologic criteria when available. Further evaluation of causality assessment was centrally performed.


RESULTS
Since April 1994 to August 2004, 461 out of 570 submitted cases, involving 505 drugs, were deemed to be related to DILI. The antiinfective group of drugs was the more frequently incriminated, amoxicillin-clavulanate accounting for the 12.8% of the whole series. The hepatocellular pattern of damage was the most common (58%), was inversely correlated with age (P < .0001), and had the worst outcome (Cox regression, P < .034). Indeed, the incidence of liver transplantation and death in this group was 11.7% if patients had jaundice at presentation, whereas the corresponding figure was 3.8% in nonjaundiced patients (P < .04). Factors associated with the development of fulminant hepatic failure were female sex (OR = 25; 95% CI: 4.1-151; P < .0001), hepatocellular damage (OR = 7.9; 95% CI: 1.6-37; P < .009), and higher baseline plasma bilirubin value (OR = 1.15; 95% CI: 1.09-1.22; P < .0001).


CONCLUSIONS
Patients with drug-induced hepatocellular jaundice have 11.7% chance of progressing to death or transplantation. Amoxicillin-clavulanate stands out as the most common drug related to DILI.
Andrade
Raúl J
RJ
Unidad de Hepatología y Grupo de Estudio para las Hepatopatías Asociadas a Medicamentos, Coordinating Centre, Hospital Universitario Virgen de la Victoria, Facultad de Medicina, Campus Universitario de Teatinos s/n, Málaga, Spain. andrade@uma.es
Lucena
M Isabel
MI
Fernández
M Carmen
MC
Pelaez
Gloria
G
Pachkoria
Ketevan
K
García-Ruiz
Elena
E
García-Muñoz
Beatriz
B
González-Grande
Rocio
R
Pizarro
Angeles
A
Durán
José Antonio
JA
Jiménez
Manuel
M
Rodrigo
Luis
L
Romero-Gomez
Manuel
M
Navarro
José María
JM
Planas
Ramón
R
Costa
Joan
J
Borras
Africa
A
Soler
Aina
A
Salmerón
Javier
J
Martin-Vivaldi
Rafael
R
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000009:adverse effects* / Q000627:therapeutic use; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008099:Liver / Q000187:drug effects*; D008107:Liver Diseases / Q000453:epidemiology; D017093:Liver Failure / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011336:Probability; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis
D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination