title: Mortality and drug exposure in a 5-year cohort of patients with chronic liver disease.
abstract: BACKGROUND
  Chronic liver diseases are common in the general population. Drug treatment in this group may be challenging, as many drugs are hepatically metabolised and hepatotoxic.
  
  
  OBJECTIVE
  We aimed to assess the mortality of patients with chronic liver disease according to specific drug exposures and the three laboratory parameters creatinine, bilirubin and International Normalised Ratio (INR).
  
  
  METHODS
  We conducted a multicentre, 5-year retrospective cohort study in two tertiary university referral hospitals and a secondary referral hospital, using a research database to evaluate the crude and adjusted mortality.
  
  
  RESULTS
  Of 1159362 individual patients 1.7% (n = 20158) had chronic liver disease and in this group 36.8% had unspecified chronic non-alcoholic liver disease, 30.1% chronic hepatitis C and 11.9% cirrhosis of the liver. 8.4% of patients presented a diagnosis associated with alcohol. The 4-year survival rates were significantly higher in the group with the most normal laboratory values (94.3%) versus 34.5% in the group with elevated parameters (p <0.001). Overall, drug exposure was not associated with higher mortality; in adjusted multivariate analysis the hazard ratio for anti-cancer drugs was 2.69 (95% CI 1.32-5.46). Of individual drugs, mortality hazard ratios for amiodarone, morphine oral, acetazolamide, sirolimus and lamivudine were 2.46 (95% CI 1.68-3.61), 2.26 (95% CI 1.78-2.86), 2.10 (95% CI 1.19-3.70), 1.81 (95% CI 1.02-3.21) and 1.72 (95% CI 1.17-2.53) respectively.
  
  
  CONCLUSIONS
  Drug exposure in general was not associated with higher mortality except for a few categories. Mortality in patients with chronic liver disease was high and is associated with simple laboratory values.
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA. bhug@uhbs.ch
authors.forename: B L
authors.initials: BL
authors.lastname: Hug
authors.forename: S R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: D L
authors.initials: DL
authors.lastname: Seger
authors.forename: A S
authors.initials: AS
authors.lastname: Karson
authors.forename: S C
authors.initials: SC
authors.lastname: Wright
authors.forename: D W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D056487:Chemical and Drug Induced Liver Injury, Chronic / Q000453:epidemiology*; D002908:Chronic Disease; D015331:Cohort Studies; D006785:Hospitals, University; D006801:Humans; D008103:Liver Cirrhosis / Q000139:chemically induced / Q000401:mortality*; D055553:Prescription Drugs / Q000009:adverse effects*; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology
chemical_list: D055553:Prescription Drugs