Hospital admissions for drug-induced liver injury: clinical features, therapy, and outcomes.
We investigated clinical features, therapy, and outcomes of patients hospitalized for drug-induced liver injury (DILI). DILI resolution was defined as liver biochemistry values back to normal or lower than CIOMS laboratory criteria; Chronicity was defined as persistent biochemical abnormality for >6 months after drugs' withdrawal. Three-hundred cases were reviewed retrospectively; mean age 51 (13-86) years, and 204 (68 %) were females. It included 267 (89 %) hepatocellular injury, 16 (5.3 %) cholestatic injury, and 17 (5.7 %) mixed injury cases. In hepatocellular injury group, 197 (73.8 %) patients with TBIL < 10× ULN included 142 (72.1 %) females and 70 (26.2 %) patients with TBIL ≥ 10× ULN included 39 (55.7 %) females (P = 0.012). Of 70 patients (TBIL ≥ 10× ULN), 20 were treated with steroid step-down therapy (79 ± 26 days) and others with non-steroid therapy. The steroid therapy group showed higher DILI resolution rate (P = 0.029) and shorter recovery time (P = 0.012). Notably, 274/300 (91.3 %) patients resolved, 18/300 (6 %) developed chronic liver injury, 7/300 (2.3 %) died, and one patient received liver transplantation. In death group, TBIL, ALB, PT, and PTA revealed more severe abnormality than in recovery group. In 121/300 (40.3 %) patients, use of herbal medicines was the leading cause of liver injury, followed by antibiotics, cardiovascular drugs, and endocrine drugs. We concluded that step-down steroid therapy for DILI improved curative effect, shortened disease course, and was safe.
Department of Infectious Diseases and Center for Liver Diseases, Peking University First Hospital, No. 8, XiShiKu Street, XiCheng District, Beijing 100034, China.
Feng-Qin
FQ
Hou
Zheng
Z
Zeng
Gui-Qiang
GQ
Wang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000378:metabolism; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001663:Bilirubin / Q000378:metabolism; D002317:Cardiovascular Agents / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000201:enzymology / Q000473:pathology / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D028321:Plant Preparations / Q000009:adverse effects; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002317:Cardiovascular Agents; D028321:Plant Preparations; D013256:Steroids; D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase; D001663:Bilirubin