Analysis Of Risk Factors And Prognosis Of Liver Failure In Drug-induced Liver Injury

BackgroundDomestic epidemiological investigation shows that the number of cases of drug-induced liver injury is increasing year by year.The incidence of DILI in the general population of China is at least 23.80/100,000 per year,higher than that of European and American,which has attracted the attention of clinicians.According to statistics,there are more than 30,000 kinds of drugs and chemicals that may cause liver damage,and more than1,100 drugs with potential hepatotoxicity are on the market.Foreign study shows that the most common kind of drug causing DILI has acetaminophen,antibiotic drug,NSAIDS,amiodarone and anti-tuberculosis drug.Domestic literature reported that Chinese herbal medicine,anti-tuberculosis drugs,anti-microbial drugs,antipyretic analgesics,anti-tumor drugs rank the top five.At present,there are many studies on drug-induced liver injury both at home and abroad.Many studies have shown that old age,female,chronic disease,and history of alcohol consumption are the susceptibility factors for DILI.At least 6% of patients in the Drug-induced liver injury research Network prospective study had a history of chronic liver disease.With the increasing number of patients with drug-induced liver injury,some hospitalized patients with drug-induced liver injury developed into liver failure,which seriously threatened the safety of the patients and affected the prognosis of the patients.The risk factors for drug-induced liver failure and drug-induced liver injury may be different depending on the severity of the disease.Current studies at home and abroad indicate that the progression to severe hepatitis in patients with drug-induced liver injury may be related to the presence of basic liver disease,age,visiting time,diagnostic type and body mass index.ObjectiveThis paper,combined with the research hotspot of drug-induced liver failure in recent years,discusses the risk factors of liver failure in patients with drug-induced liver injury,analyzes the prognosis of drug-induced liver failure patients,and provides early prevention and reasonable treatment for patients.MethodsA total of 66 patients with drug-induced liver failure who were hospitalized in the First Affiliated Hospital of Chongqing Medical University in recent 7 years were selected as the liver failure group,and66 patients with drug-induced liver injury were selected as the control group.The risk factors of drug-induced liver failure were analyzed retrospectively.According to the prognosis of 66 patients with drug-induced liver failure,they were divided into improvement group and ineffective group,and the prognostic factors of drug-induced liver failure were analyzed.The selected factors included age,sex,type of medication,underlying disease,and laboratory tests(WBC,PLT,Hb,ALT,AST,ALP,Tbil,Scr,INR,etc).Logistic regression analysis was used to analyze single factor and multi factor.P < 0.05 was statistically significant,and ROC curve was drawn.All data were statistically processed with software SPSS22.0.Results1.The incidence of drug-induced liver failure in our hospital is similar between men and women,and the age is mainly middle aged.The incidence of drug-induced liver injury is higher in women,and the age is mainly middle-aged.The improvement rate of liver failure group after treatment was about 48.5%.2.The top three suspected drugs in the liver injury group were Chinese herbal medicine,anti-tuberculosis drugs and cold drugs in order.The top three suspected drugs in liver failure group were anti-tuberculosis drugs,Chinese herbal medicine,and cold drugs in order.Hepatocyte injury was the main type in both clinical types.3.Analysis results of liver failure group and control group: Univariate analysis showed that there were statistically significant differences between the two groups in combination with hepatitis B,alcohol history,drug type,CTP score,MELD score and some laboratory test values(Hemoglobin,platelets,fasting glucose,albumin,γ-GGT,PTA,leukocyte,blood ammonia,total bilirubin,AST,AST/ALT,INR).Multivariate analysis showed that hepatitis B,leukopenia,hemoglobin and thrombocytopenia were independent risk factors for liver failure.4.Analysis results of the improvement group and the invalid group:Univariate analysis showed that some laboratory test values(hemoglobin,albumin,ALT,PTA,total bilirubin,INR,AST/ALT),MELD score and CTP score had statistically significant differences between the two groups.High CTP score and low PTA are independent risk factors for poor prognosis of drug-induced liver failure.ROC analysis of PTA and CTP score showed that when PTA < 26.7%,CTP score>at 10.5 points had a stronger predictive ability for the failure of drug-induced liver failure treatment.ConclusionThere are many risk factors for liver failure in patients with drug-induced liver injury.It is necessary to actively prevent and cure infection,correct anemia and thrombocytopenia,and delay the progress of the disease in patients with drug-induced liver injury.Hepatitis B patients using anti-tuberculosis drugs,traditional Chinese medicine and other high-risk liver damage drugs,should be more alert to the occurrence of liver failure.Patients with drug-induced liver failure with cirrhosis complications and significantly abnormal coagulation function have a poor prognosis.