The Clinical Features And Prognosis Analysis Of 498 Patients With Drug-induced Liver Injury

Objective:The study retrospectively analyzed the inpatient medical records of 498 cases with deug-induced liver injury(DILI)in The Second Affiliated Hospital of Kunming Medical University in the past 7 years.To investigate the Epidemiology,the risk factors,the clinical characteristics,treatment and prevention of DILI.In order to provide reference for clinicians in the diagnosis,treatment and prevention of DILI.Methods:712 patients who were diagnosed with DILI in The Second Affiliated Hospital of Kunming Medical University from July 2013 to 2019 were collected,and 498 patients were included in the study.To collect all patients’ demographics,medical history,clinical features,laboratory inspection,treatment,severity and mortality rate.Results:1.The annual composition ratio of DILI inpatients from 2013 to 2019 was gradually increasing and the most accounted for 16.23%.The ratio of male to female was 1:1.05 and women patients were more common.The age of patients mainly concentrated on 37-68 years old,accounting for 68.47%.There were significant differences in different age among the gender(P=0.000).Minority patients accounted for 20.68%.Among the underlying diseases that cause DILI medication,the top three were:digestive diseases(25.90%),respiratory diseases(16.47%),tumor diseases(9.44%).26.91%had basic liver disease.16.87%had allergies.2.Among the suspicious drugs that cause DILI,single medication accounted for 89.56%,including Chinese medicine(56.43%),antitumor and immune modulators(8.03%),anti-infective drugs(4.42%),antipyretic and analgesics(4.22%),etc.The combined drugs accounted for 10.44%.3.The patients with acute onset accounted for 97.19%.The severity of inpatients with DILI is mainly grade 3 severe liver injury.The most common clinical type was hepatitis(63.05%).The hepatitis is more common in the 37-52 years old(26.70%),and the cholestasis is more common in the 53-68 years old(7.20%).There were significant differences in clinical type among the different age(P=0.000).Fourteen patients had a history of DILI,and three patients had chronic hepatitis by liver biopsy.Most patients with onset of medication for 5-30 days.The clinical manifestations of DILI lack specificity,and the most common symptoms are multiple clinical manifestations.Among the DILI caused by different drugs,there were significant differences in Age,ALT,AST,ALP,TBIL,TBA(P=0.000,P=0.049,P=0.004,P=0.049,P=0.000,P=0.000).ALT、AST、ALP、GGT、TBA、INR、eosinophilic granulocyte were the significant indicator of laboratory indicators(P=0.000,P=0.000,P=0.000,P=0.000,P=0.018,P=0.003,P=0.019).Autoantibody were more common with antinuclear antibodies(ANA),a total of 55 cases,of which ANA(nuclear particle type)was the main,with a titer of up to 1:1000.Abdominal ultrasound and magnetic resonance imaging are most often based on abnormal liver parenchymal signals.The pathological changes of 54 patients with liver biopsy were mainly chronic hepatitis.4.96.99%of DILI patients were cured or improved and 3.01%of patients are not cured.There are significant differences in clinical classification,ALB,ALT,GGT,and INR levels in the prognostic grouping(P values were 0.004、0.000、0.000、0.033).Ordinal Regression showed that GGT and INR were independent factors with poor prognosisConclusion:The morbidity of DILI was gradually ascending.It mainly happened to the middle-aged women.Suspicious medications are common with TCM/HDS,antitumor and immunomodulators,anti-infective drugs,antipyretic and analgesics.The clinical manifestations of DILI lack specificity.The most common clinical type was hepatitis.The severity of inpatients with DILI is mainly grade 3 severe liver injury.Most patients with DILI had a good prognosis after discontinuation.The overall prognosis of DILI was better at GGT and INR were independent predictors of poor prognosis.