Features and outcomes from a retrospective study of 570 hospitalized Chinese patients with drug-induced liver injury

Pang, Liwei; Yang, Wanna; Hou, Fengqin

doi:10.1016/j.clinre.2017.08.003

Cited by 23 publications

(29 citation statements)

References 26 publications

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“…In the study by Pang et al, 57 chronic DILI cases out of 570 cases (10%) were analyzed, and it was pointed out that chronicity was more common in cholestatic and mixed injury patients. 29 Similarly, we found that patients with the mixed pattern were more prone to chronicity, and they were of a younger age and had a higher percentage of lymphocytes than the hepatocellular and cholestatic pattern. This might be associated with the immune system's overreaction in young people, which could lead to increased lymphocytes to liver parenchyma, and induce hepatocyte and biliary epithelial cells damage.…”

Section: Discussionsupporting

confidence: 61%

“…Through a multivariate Logistic regression analysis and receiver operating characteristic curve analysis, T 0.5TBIL also represented an independent risk factor of chronic DILI, and had the predictive value of distinguishing chronic and recovered DILI. In the study by Pang et al ., 57 chronic DILI cases out of 570 cases (10%) were analyzed, and it was pointed out that chronicity was more common in cholestatic and mixed injury patients . Similarly, we found that patients with the mixed pattern were more prone to chronicity, and they were of a younger age and had a higher percentage of lymphocytes than the hepatocellular and cholestatic pattern.…”

Section: Discussionmentioning

confidence: 50%

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Prolonged interval of total bilirubin decline is an early independent predictive factor of chronic persistent drug‐induced liver injury

Zhu

Wang

Zhao

et al. 2019

Hepatology Research

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Aim Chronic drug‐induced liver injury (DILI) with persistent abnormal liver function tests (LFTs) >6 months after cessation of the insulting drugs could progress to cirrhosis. The aim of the present study was to identify the risk factors of chronic DILI for early recognition and better management. Methods History of drug intake and results of LFTs were retrospectively retrieved for patients with a discharge diagnosis of DILI for at least 1‐year follow up. The risk factors independently associated with chronic DILI were analyzed by multiple logistic regression analyses. Results A total of 33 of the 140 DILI patients had persistent abnormal LFTs >6 months, which were considered as chronic DILI. It was found that the time intervals of alanine aminotransferase and total bilirubin decline from the peak to their half peak (T0.5ALT, T0.5TBIL) were significantly longer in the chronic DILI group than that in the recovered group (P = 0.001 and P < 0.001). The risk factors associated with chronic DILI independently were T0.5TBIL (OR 1.315, 95% CI 1.038–1.668), longer period of insulting drug(s) intake (OR 1.018, 95% CI 1.003–1.033), mixed/cholestatic pattern (OR 97.159, 95% CI 1.866–5005.994). More importantly, receiver operating characteristic curve analysis showed that the prognostic value of T0.5TBIL for chronic DILI had a sensitivity of 60.0% at a specificity of 90.7% with the threshold of 16 days. Conclusions The time intervals of total bilirubin decline from its peak to half of its peak (T0.5TBIL) was an early independent predictive factor of chronic DILI, suggesting that T0.5TBIL might serve as an indicator for chronicity.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 50%

Prolonged interval of total bilirubin decline is an early independent predictive factor of chronic persistent drug‐induced liver injury

Zhu

Wang

Zhao

et al. 2019

Hepatology Research

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“…Normalization was defined as that the levels of ALT and/or AST were <1×ULN (40 U/L) and total bilirubin (TB) <1.5 × ULN (30.78 µmol/L) . ‘Chronic DILI’ was defined as that liver biochemical parameters failed to normalize within 6 months …”

Section: Methodsmentioning

confidence: 99%

“…7 'Chronic DILI' was defined as that liver biochemical parameters failed to normalize within 6 months. 30,33…”

Section: Follow-upmentioning

confidence: 99%

Clinicopathological features of Bu Gu Zhi‐induced liver injury, a long‐term follow‐up cohort study

Wang

Wee

Soon

et al. 2019

Liver International

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Background & Aims Bu Gu Zhi (BGZ) is a Chinese herb consumed mainly for osteoporosis treatment. Only small case series of BGZ‐induced liver injury (BGZILI) have been reported. We describe the clinicopathological features and clinical course of BGZILI. Methods Patients diagnosed with drug‐induced liver injury (DILI) at Beijing Friendship Hospital from 2005 to 2017 were reviewed. Clinical and follow‐up data were analysed. Results Of the 547 DILI patients, 40 cases (7.3%) were attributed to BGZILI. About 34/40 (85.0%) patients were females with a median age of 63 (range, 54‐70) years. The median latency period was 45 (range, 29‐90) days. Patients commonly presented with loss of appetite (57.5%), dark urine (57.5%) and fatigue (55.0%). The median level of alanine aminotransferase and aspartate aminotransferase at BGZILI onset was 673.5 and 423.0 U/L respectively. Total bilirubin (TB) and direct bilirubin (DB) were 59.0 and 39.4 µmol/L respectively. The biochemical liver injury pattern was hepatocellular (92.5%), cholestatic (5.0%) and mixed (2.5%). They were categorized into ‘mild’ (N = 23, 57.5%), ‘moderate’ (6, 15.0%) or ‘severe’ (11, 27.5%) according to severity assessment by DILI network. The main histological injury pattern in 9/40 patients with liver biopsy was acute hepatitis with/without cholestasis. Median duration of follow‐up was 26.3 months with recovery in 37 patients within 6 months. No patients died or required transplantation. Conclusions BGZ‐induced liver injury manifested more often as a hepatocellular injury pattern with mild to moderate hepatocellular damage. Most patients recovered after cessation of BGZ within 6 months, and none developed end‐stage liver disease or died.

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“…Some studies have refuted the effects of corticosteroids in DILI . Karkhanis et al retrospectively evaluated the effect of steroids in ALF.…”

Section: Efficacy Of Corticosteroid Treatment In Dili: Pros and Consmentioning

confidence: 99%

Corticosteroid therapy in drug‐induced liver injury: Pros and cons

Xie

2019

J of Digest Diseases

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Drug‐induced liver injury (DILI) is a liver toxicity induced by a drug or its metabolite. The incidence of DILI continues to increase and it has been an enormous challenge worldwide, while the prognosis is not optimistic. Currently, the most effective treatment for DILI is to suspend the offending drug(s) and to avoid re‐exposure, with no definitive therapy available for idiosyncratic DILI with or without acute liver failure. Given the anti‐inflammatory effects of corticosteroids, they have been widely used in DILI in clinical practice, although their efficacy remains controversial. Several studies have shown their beneficial effects but a few reports have refuted the efficacy of corticosteroids in treating patients with DILI. In this review, we summarized the history and current status of corticosteroid use in liver diseases and the pros and cons of corticosteroid treatment in DILI, and we explored the DILI candidates who may benefit from corticosteroid therapy, the administration route and dosage, and the adverse effects related to corticosteroid use.

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Features and outcomes from a retrospective study of 570 hospitalized Chinese patients with drug-induced liver injury

Cited by 23 publications

References 26 publications

Prolonged interval of total bilirubin decline is an early independent predictive factor of chronic persistent drug‐induced liver injury

Prolonged interval of total bilirubin decline is an early independent predictive factor of chronic persistent drug‐induced liver injury

Clinicopathological features of Bu Gu Zhi‐induced liver injury, a long‐term follow‐up cohort study

Corticosteroid therapy in drug‐induced liver injury: Pros and cons

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