Outcomes and Predictors of Mortality in Patients With Drug-Induced Liver Injury at a Tertiary Hospital in South India: A Single-Centre Experience

Abstract

Introduction: Drug-induced liver injury (DILI) is an important cause of acute liver failure with significant morbidity and mortality. The outcome of DILI varies widely according to the drug implicated and the type of liver injury. Owing to the heterogeneous nature of liver injury, knowledge on clinical course and prognosis of DILI is limited. We had undertaken this study to determine the clinical characteristics, outcomes, and predictors of mortality in patients with DILI. Materials and methods: This prospective study was conducted from January 2015 through December 2018. We analyzed the drugs implicated, clinical course, and the outcome. Causality assessment was performed by using Roussel Uclaf Causality Assessment Method scoring. Patients were followed for 6 months until recovery/death or liver transplantation. Results: There were 133 cases with DILI. The mean age was 47.6 years, and 51.9% of them were men. Drugs causing DILI were antitubercular drugs (37.5%) followed by neuropsychiatric drugs (16.5%), antibiotics/antifungals (12%), complementary and alternative medicine (10.5%), immunomodulatory/chemotherapeutic drugs (10.5%), and nonsteroidal antiinflammatory drugs (7.5%). Eighty-two (61.6%) patients were classified as hepatocellular, 30 (22.5%) as mixed and 21 (15.7%) as cholestatic type of injury. There was no significant difference in the mortality and morbidity between the three types of liver injury. There were 18 deaths (13.5%), of which antitubercular drugs constituted the majority (55.5%) followed by neuropsychiatric drugs (27.7%) and complementary and alternative medicine (16.6%). Based on receiver operating characteristic curve analysis, model for end-stage liver disease (MELD) score >28, mean international normalized ratio (INR) >1.97, mean bilirubin level >15.6 mg/dl, and creatinine level >1.35 mg/dl were associated with mortality. Conclusion: Although DILI is uncommon, it has significant morbidity and mortality. Antitubercular drugs were the most common cause for DILI and DILI-related mortality in our study. Variables such as MELD, INR, bilirubin, albumin, and creatinine help in predicting severity of liver injury and may help in triaging the patient for referral for liver transplantation.

Study on the Characteristics of Small-Molecule Kinase Inhibitors-Related Drug-Induced Liver Injury

“…DILI is the main cause of acute liver failure ( Sunil Kumar et al, 2021 ), and it is very important to predict and prevent DILI. We collected the information of drug properties and DILI endpoints of FDA-approved drugs and studied the risk factors toward DILI and the associations between KIs and DILI.…”

“…It has been reported that the DILI occurrence was associated with the drug types ( Sunil Kumar et al, 2021 ). Anti-tumor drugs, heparin, antibacterial drugs, and anti-tuberculosis drugs are the most common drug categories that cause DILI in clinical practice ( Meier et al, 2005 ).…”

Progress and Challenges in the Use of a Liver-on-a-Chip for Hepatotropic Infectious Diseases

“…Drugs and drug metabolites are capable of damaging the liver, resulting in a spectrum of symptoms ranging from mild to acute liver failure. The most common drugs inducing liver injury are antimicrobials [ 72 , 73 , 74 ]. Despite the rare incidence and uncommon cause of acute liver failure, DILI poses a threat to morbidity and mortality.…”