title: Causes, Features, and Outcomes of Drug-Induced Liver Injury in 69 Children from China.
abstract: OBJECTIVE
  Drug-induced liver injury (DILI) is a frequent cause of pediatric liver disease; however, the data on DILI are remarkably limited.
  
  
  METHODS
  All 69 children hospitalized with DILI between January 2009 and December 2011 were retrospectively studied.
  
  
  RESULTS
  A total of 37.7% of the children had medical histories of respiratory infection. The clinical injury patterns were as follows hepatocellular 89.9%, cholestatic 2.9%, and mixed 7.2%. Liver biopsies from 55 children most frequently demonstrated chronic (47.3%) and acute (27.3%) hepatitis. Hypersensitivity features, namely, fever (31.9%), rash (21.7%), and eosinophilia (1.4%), were found. Twenty-four children (34.8%) developed chronic DILI. Antibiotics (26.1%) were the most common Western medicines (WMs) causing DILI, and the major implicated herbs were Ephedra sinica and Polygonum multiflorum. Compared with WM, the children whose injuries were caused by Chinese herbal medicine (CHM) showed a higher level of total bilirubin (1.4 mg/dL vs. 16.6 mg/dL, p=0.004) and a longer prothrombin time (11.8 seconds vs. 17.3 seconds, p=0.012), but they exhibited less chronic DILI (2/15 vs. 18/39, p=0.031).
  
  
  CONCLUSIONS
  Most cases of DILI in children are caused by antibiotics or CHM used to treat respiratory infection and present with hepatocellular injury. Compared with WM, CHM is more likely to cause severe liver injury, but liver injury caused by CHM is curable.
authors.affiliation: Integrative Medicine Center, 302 Military Hospital, China.|Medical School of Chinese PLA, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Integrative Medicine Center, 302 Military Hospital, China.
authors.forename: Yong-Gang
authors.initials: YG
authors.lastname: Li
authors.affiliation: China Military Institute of Chinese Medicine, Beijing, China.
authors.forename: Jia-Bo
authors.initials: JB
authors.lastname: Wang
authors.affiliation: Department of Pathology, 302 Military Hospital, Beijing, China.
authors.forename: Shu-Hong
authors.initials: SH
authors.lastname: Liu
authors.affiliation: Integrative Medicine Center, 302 Military Hospital, China.
authors.forename: Li-Fu
authors.initials: LF
authors.lastname: Wang
authors.affiliation: China Military Institute of Chinese Medicine, Beijing, China.
authors.forename: Yan-Ling
authors.initials: YL
authors.lastname: Zhao
authors.affiliation: Integrative Medicine Center, 302 Military Hospital, China.
authors.forename: Yun-Feng
authors.initials: YF
authors.lastname: Bai
authors.affiliation: Integrative Medicine Center, 302 Military Hospital, China.
authors.forename: Zhong-Xia
authors.initials: ZX
authors.lastname: Wang
authors.affiliation: Integrative Medicine Center, 302 Military Hospital, China.
authors.forename: Jian-Yu
authors.initials: JY
authors.lastname: Li
authors.affiliation: China Military Institute of Chinese Medicine, Beijing, China.
authors.forename: Xiao-He
authors.initials: XH
authors.lastname: Xiao
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001663:Bilirubin / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000209:etiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D002681:China; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D011517:Prothrombin Time; D012141:Respiratory Tract Infections / Q000150:complications* / Q000188:drug therapy; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D004365:Drugs, Chinese Herbal; D001663:Bilirubin
keywords: Chinese herbal medicine; Diagnosis; Hepatotoxicity; Liver biopsy; Pediatric