The predictors of complications in patients with drug-induced liver injury caused by antimicrobial agents.
BACKGROUND
Antimicrobials are the leading cause of idiosyncratic drug-induced liver injury in most series.


OBJECTIVE
To determine the incidence and the predictors of complications in patients with drug-induced liver injury caused by antimicrobial agents requiring hospitalization.


METHODS
Medical records of patients with drug-induced liver injury caused by antimicrobial agents were identified by ICD-10, for the period between 2002 and 2006. Clinical information and blood tests during hospitalization were recorded. The causality assessment of drug-induced liver injury was determined by the Roussel UCLAF causality assessment method (RUCAM) scale.


RESULTS
Of 47 594 in-patient admissions per year, the annual incidence of drug-induced liver injury was 0.03%. Male: female ratio was 7:3 with a median age of 47 years. Eighty reactions of drug-induced liver injury were caused by anti-tuberculosis drugs (85%) and by antibiotics (15%). The median (IQR) of RUCAM scale was 6 (5-8). A total of 36% had HIV infection and 9% of patients had diabetes mellitus. Median (IQR) duration of hospitalization was 9 (5-15) days. Serious complications and death were found in 27.5% and 26%, respectively. By a multivariable logistic analysis, the presence of jaundice was found to be significantly associated with an unfavourable outcome.


CONCLUSIONS
Although rare, antimicrobial agents-related drug-induced liver injury requiring hospitalization has a high mortality rate. The presence of jaundice predicts poor outcome.
Treeprasertsuk
S
S
Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. battan5410@yahoo.com <battan5410@yahoo.com>
Huntrakul
J
J
Ridtitid
W
W
Kullavanijaya
P
P
Björnsson
E S
ES
D000328:Adult; D000890:Anti-Infective Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D007565:Jaundice / Q000150:complications; D008099:Liver / Q000187:drug effects*; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
D000890:Anti-Infective Agents