Single-Center Experience With Drug-Induced Liver Injury From India: Causes, Outcome, Prognosis, and Predictors of Mortality

Abstract

Although drug-induced liver injury (DILI) is rare, it may result in signifi cant morbidity or death. The causes and outcome vary according to regions, with acetaminophen and complementary medicines common in the West and the Far East, respectively. This study evaluates the causes, outcomes, predictors, and models for 90-day mortality from DILI from India. METHODS:Consecutive patients with DILI from 1997 to 2008 based on International Consensus Criteria from a medical college hospital setting were studied. RESULTS:Of the 313 patients, 58 % were males. Leading causes were a combination of four anti-tuberculous drugs (ATDs) (58 % ), anti-epileptics ( SUPPLEMENTARY MATERIAL is linked to the online version of the paper at

An Update on Drug-induced Liver Injury

“…29 Hy's law has been corroborated in several studies [18][19][20] including a recent single center study from India, which found a mortality of 21.5% in a setting where transplantation was not available. 9 Some drugs producing hepatotoxicity do not fit into a particular pattern, taking months and years of cumulative use to produce injury ( Table 2). Often they cause very minimal or no rise in liver enzymes.…”

“…In a single center study from India, DILI contributed to 1.4% of all gastrointestinal admissions and 2.5% of hepatobiliary admissions with a gradual increase in the numbers over the years. 9 In those presenting to the hospital with jaundice only a small minority of patients (0.7%) were due to idiosyncratic DILI. 10 The common drugs causing DILI appear geographical.…”

“…Although antimicrobials are the commonest cause of drugs worldwide, the class of antimicrobials varies geographically, with amoxicillin and flucloxacillin common in the Europe 11 in contrast to antituberculosis drugs in India. 9 DILI is a leading cause of acute liver failure (ALF) in the Western world, with paracetamol being the commonest drug followed by antimicrobials. 12,13 In India antituberculosis drugs are the commonest cause of druginduced ALF in adults and children, [14][15][16] contributing to 5.7-22% of all cases of ALF.…”

“…14,17 A brief summary of drugs causing hepatotoxicity and other demographic characteristics are depicted in Table 1. 9,[18][19][20][21] …”

Valproic acid induced acute liver injury resulting in hepatic encephalopathy- a case report and literature review

“…Our case describes altered mental status, hyperammonemia, deranged LFTs as the presenting signs of DILI distinguishing it from VHE. Early diagnosis and management of DILI is very important as it has high mortality ranging from 11.7% to 17.3% [25]. Due to the poor prognosis of DILI, clinicians must do a thorough work up in the patient taking VPA with altered mental status as it may be a sign of DILI and unrelated to hyperammonemia.…”