title: A prospective study of acute drug-induced liver injury in patients suffering from non-alcoholic fatty liver disease.
abstract: OBJECTIVE
  Liver damage due to facultative hepatotoxins is scarcely foreseeable. We evaluated the prevalence of acute drug-induced liver injury (DILI) in a specific setting, assessing eventual interactions with pre-existing hepatic illnesses.
  
  
  METHODS
  The research was carried out in an Italian tertiary care hospital, by analyzing 248 patients with non-advanced liver disease, divided into two well-matched groups: 174 patients (median age 53, 94 females) with hepatitis C virus-related chronic hepatitis; and 74 (median age 55, 39 females) with non-alcoholic fatty liver disease (NAFLD).
  
  
  RESULTS
  Six patients (2.4% of the whole population) belonging to the NAFLD group (chi(2)-test, P = 0.004) suffered from acute hepatoxicity related to the following drugs, that is antihypertensive, acting on platelet aggregation, antimicrobial, non-steroidal anti-inflammatory and proton pump inhibitor. The NAFLD presence was an independent risk factor in determining drug-related acute hepatitis, with an odds ratio of 3.95 (95% confidence intervals: 11.48-1.35). Central obesity was relevant in every patient with acute toxicity. Alcohol consumption and drug association did not influence the acute drug-induced liver damage.
  
  
  CONCLUSIONS
  NAFLD conveys a nearly fourfold increase of DILI risk in obese middle-aged patients. NAFLD, characterized by mitochondrial dysfunction, could predispose to drug-induced hepatotoxicity that probably shares the same pathophysiological mechanism.
authors.affiliation: Department of Clinical and Experimental Medicine, Federico II University Medical School of Naples, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tarantino
authors.forename: Paolo
authors.initials: P
authors.lastname: Conca
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Basile
authors.forename: Antonio
authors.initials: A
authors.lastname: Gentile
authors.forename: Domenico
authors.initials: D
authors.lastname: Capone
authors.forename: Giuliano
authors.initials: G
authors.lastname: Polichetti
authors.forename: Emilio
authors.initials: E
authors.lastname: Leo