The Clinical Characteristics And Prognosis Of 219 Patients With Drug-induced Liver Injury

Objective: To analyze the clinical features and prognostic factors of drug-induced liver injury(DILI),so as to provide reference for clinical rational drug use,early detection and diagnosis of drug-induced liver injury.Methods: A total of 1361 cases hospitalized and diagnosed as "drug-induced liver injury","drug-induced liver damage",and "drug-induced hepatitis" in the First Affiliated Hospital of Guangxi Medical University from January 1,2012 to December 31,2020 were searched and scored with RUCAM scale,of which 219 patients with RUCAM score ≥ 6 were included in this study.The clinical features,treatment and prognostic factors were retrospectively analyzed.SPSS 26.0 software was used for statistical analysis.Results: 1.Of the 219 patients with DILI,there were 107 male(48.86%)and 112female(51.14%),with a male to female ratio of 1:1.05.The oldest was 89 years old,the youngest was 3 months old,with a mean age of43.74 ± 18.68 years old.Patients under 60 years of age were rare(80.37%).Patients with DILI aged 60 years and older were predominantly male(65.12%males,34.88% females),while patients under 60 years of age were less likely to be female(44.89% males,55.11% females)(P = 0.017).2.Among the underlying diseases,respiratory system diseases(33.33%)was the most common,followed by digestive system(9.13%)and endocrine system diseases(8.22%).Traditional Chinese medicine(30.14%),anti-TB drugs(12.33%),and antibiotics(11.87%)were the most common suspected drugs causing DILI in this study.3.72.15% of DILI patients occurred clinical manifestations or liver injury in 4 weeks.The hepatocellular injury type was the most common clinical classification,with a total of 160 cases(73.06%),followed by cholestasis type in42 cases(19.18%),and mixed type had the least number of cases with 17 cases(7.76%).There was no significant difference in clinical classification between age and gender(P > 0.05).4.The main clinical manifestations were yellow urine(52.51%),yellow skin and sclera(47.49%),fatigue(40.64%),and anorexia(35.16%).The main signs were yellow skin and sclera(55.25%)and abdominal tenderness(17.81%),and some patients had no obvious signs during the course of the disease(35.62%).Only 12 patients underwent liver biopsy in this study.The main manifestations were hepatocyte edema and degeneration,few punctate necrosis,accompanied by fibrous hyperplasia,bile pigment deposition in hepatocytes,and lymphocyte infiltration in the portal area,which were consistent with the histopathological findings of the liver in DILI.Among the patients with hepatocellular injury type DILI,there were 83 cases(37.90%)with mild liver injury,23 cases(10.50%)with moderate liver injury,and 54 cases(24.66%)with severe or above liver injury.There were 13 cases(5.94%),5 cases(2.28%)and 24 cases(10.96%)in mild,moderate and severe or above liver injury groups of cholestatic type.In the mixed type,there were 4 cases(1.83%)of mild liver injury,4 cases(1.83%)of moderate liver injury,and 9 cases(4.10%)of severe or above liver injury.There was no statistical difference in the severity of liver injury between sex and age(P > 0.05).The severity of liver injury varied among the different clinical types(P = 0.006).A total of 188 patients(85.84%)were cured and improved,and 31 patients(14.16%)were not cured and died.The prognosis was different between the three clinical types(P < 0.001),and the improvement rate of hepatocellular injury type was higher than that of cholestasis type and mixed type.Liver biochemical parameters decreased significantly before and after treatment in patients with the same clinical type(P< 0.05).5.In the analysis of prognostic factors,the results of univariate Logistic regression analysis showed that clinical classification,severity of liver injury and TBil,GGT,AST,ALT,ALP,PT and INR before treatment were related to prognosis(P < 0.05).After multivariate Logistic regression analysis,PT is an independent risk factor for prognosis.Patients with prolonged PT had a poor prognosis,and patients with hepatocellular injury DILI had a better prognosis than those with cholestatic disease.Conclusion: 1.DILI can occur at any age,and patients with DILI aged 60 years and older are predominantly male,while patients under 60 years of age are less common in females.2.The common suspected drugs causing DILI are mainly traditional Chinese medicines,anti-tuberculosis drugs and antibiotics.3.The occurrence of DILI is generally within 4 weeks of treatment,and the clinical classification is mainly hepatocellular injury type.4.Prolonged PT is an independent risk factor for prognosis,and patients with prolonged PT have a poor prognosis.