title: Drug-induced liver injury: a cohort study on patients referred to the Danish transplant center over a five year period.
abstract: OBJECTIVE
  The idiosyncratic subtype of drug-induced liver injury (DILI) is a rare reaction to medical treatment that in severe cases can lead to acute liver failure and death. The aim of this study was to describe the presentation and outcome of DILI and to identify potential predictive factors of poor outcome.
  
  
  METHODS
  We identified all patients diagnosed with DILI at the Department of Hepatology, Rigshospitalet, from March 2007 to November 2012. The following parameters were registered from patient files: drug causing DILI, symptoms, comorbidity, biochemistry, treatment and outcome.
  
  
  RESULTS
  Of 43 patients, 25 (58%) were female with a mean age of 54 years. The two most frequent causes of DILI were Disulfiram (30%) and antibiotics (19%). The most common symptoms were jaundice, nausea, fatigue and gastrointestinal discomfort. At the time of admission, the most frequent biochemical findings included bilirubin elevated to above 3.2 × ULN, ALT elevated to above 9 × ULN in 86%, INR above 1.4 in 70%. Twenty two patients needed treatment in the liver intensive care unit. Fifteen patients developed acute liver failure with a severe outcome. Six patients were liver transplanted and nine patients died. Jaundice, a moderately elevated bilirubin level or INR at presentation was predictive of severe outcome.
  
  
  CONCLUSIONS
  In this retrospective study, 35% of patients with DILI developed severe acute liver failure and were either liver transplanted or died. Our results underline that DILI may be severe and run a fatal course, and that bilirubin and INR levels may predict poor outcome.
authors.affiliation: a Department of Hepatology , Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark.
authors.forename: Mille
authors.initials: M
authors.lastname: Baekdal
authors.affiliation: a Department of Hepatology , Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark.
authors.forename: Henriette
authors.initials: H
authors.lastname: Ytting
authors.affiliation: a Department of Hepatology , Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Skalshøi Kjær
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001663:Bilirubin / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology*; D015897:Comorbidity; D003718:Denmark; D004221:Disulfiram / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007565:Jaundice / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001663:Bilirubin; D004221:Disulfiram
keywords: Disulfiram; Idiosyncratic drug-induced liver injury; antibiotics; hepatotoxicity; toxic hepatitis