Analysis Of The Efficacy Of Glucocorticoids In Patients With Severe Drug-induced Liver Injury

Objective:The clinical data of patients with severe DILI treated with glucocorticoid were retrospectively analyzed to explore the efficacy and safety of glucocorticoid in the treatment of severe DILI.Methods:Data of patients with severe DILI admitted to the First Clinical Medical College of Shanxi Medical University from January 2019 to September 2021 were retrospectively analyzed.Demographic characteristics,liver-damaging drugs and clinical manifestations were analyzed,and liver function changes,efficacy and adverse reactions were compared between patients treated with glucocorticoid and those not treated with corticosteroids.Results:1.A total of 88 patients were enrolled,including 33 males and 55 females,with a median age of 49 years,61 in the control group and 27 in the hormone group.Liver cell injury was the main type of liver injury.Among the liver injury drugs,Chinese medicine and health care products were the most common.The clinical manifestations were jaundice,nausea and poor appetite,and 6.82% of patients developed grade 4 DILI.Thirty-one patients were serologically positive for autoimmunity,of which 70.97% were female.2.The median levels of baseline TBIL,TBA and INR in the hormone group were higher than those in the control group,and the differences of TBIL(240.5 and 213.6μmol/L,P=0.019)between the two groups were statistically significant.The levels of TBIL,TBA and INR in the hormone group were lower than those in the control group at3 and 7 days of treatment,and the differences were not statistically significant.The decrease rates of TBIL and INR in the two groups after 3 days of treatment(TBIL33.57% and 3.18%,P<0.001;INR 46.39% and 4.58%,P=0.025)and TBA reduction rate at 7 days of treatment(82.43% and 42.6%,P=0.008)were statistically significant.3.The cumulative effective rate was 59.26% and 81.48% in hormone group and29.51% and 29.51% in control group,respectively,with statistical significance(P<0.05);In the hormone group,all the patients with grade 4 DILI were ineffective,while 93.75%of the patients who were treated with hormone were effective because of the decrease of liver enzymes but no significant increase or decrease of bilirubin after conventional liver preservation therapy.4.In the hormone group,1 patient had elevated blood glucose,2 patients had respiratory tract infection,and 2 patients in the control group had respiratory tract infection.After symptomatic treatment,the adverse reactions disappeared.Conclusion:Traditional Chinese medicine and dietary supplements are the most common liver-damaging drugs.Female DILI patients are more likely to show autoimmune characteristics.Short-term use of corticosteroids may benefit patients with grade 3 DILI whose bilirubin reduction is not ideal after conventional treatment,and there are no significant adverse reactions.