title: Etiology of new-onset jaundice: how often is it caused by idiosyncratic drug-induced liver injury in the United States?
abstract: OBJECTIVE
  The epidemiology of acute drug-induced liver injury (DILI) in the United States has not been well studied. We conducted a study of adults with new-onset jaundice at a nonreferral community hospital to better understand the epidemiology of acute DILI.
  
  
  METHODS
  This is a retrospective study of adult outpatients and inpatients (> or =18 yr) with new-onset jaundice over a 5-yr period (1999-2003) at Wishard Memorial Hospital, Indiana. Patients with new-onset jaundice were identified using our electronic medical record system and individual medical records were reviewed to extract the required clinical data. New-onset jaundice was defined as the presence of total serum bilirubin >3 mg/dL in patients without a prior total bilirubin >3 mg/dL.
  
  
  RESULTS
  A total of 732 eligible adults constituted our study cohort. Sepsis or altered hemodynamic state resulting in presumed ischemic liver injury is the single most common cause of jaundice (22%). Acute liver disease as a result of nonalcoholic etiologies caused new-onset jaundice in 97 patients (13%), with acute viral hepatitis in 66 patients (9%) and DILI in 29 patients (4%). Most cases of DILI were as a result of acetaminophen toxicity with idiosyncratic DILI occurring in only five patients (0.7%). No mortality was observed at 6 wk in patients who developed idiosyncratic DILI.
  
  
  CONCLUSIONS
  Idiosyncratic DILI appears to be a rare cause of new-onset jaundice in a community hospital setting.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
authors.forename: Raj
authors.initials: R
authors.lastname: Vuppalanchi
authors.forename: Suthat
authors.initials: S
authors.lastname: Liangpunsakul
authors.forename: Naga
authors.initials: N
authors.lastname: Chalasani
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007196:Indiana / Q000453:epidemiology; D007565:Jaundice / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D008107:Liver Diseases / Q000097:blood / Q000150:complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin