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

Objective: To investigate the risk factors of liver failure in drug-induced liver injury(DILI)and provide clinical reference for the prevention and treatment.Methods: The clinical data of 141 patients with DILI admitted in the First Affiliated Hospital,Jinan University from January 2015 to December 2021 were collected.The subjects included in the study were divided into a liver failure(LF)group and a non-liver failure(NLF)group.Univariate analysis,multivariate Logistic analysis,and receiver operating characteristic(ROC)analysis were used to explore the clinical characteristics and risk factors of liver failure in DILI.Results:(1)Among the 141 patients with DILI,the male-to-female ratio was1.61:1,the median age was 51.0(37.5,66.0)years old,and most patients were in the age group of 45-55 years.The top three drug types that cause DILI were traditional Chinese medicine or Chinese patent medicine(27.7%),non-steroidal anti-inflammatory drugs(23.4%),and anti-infective drugs(13.8%).Liver failure occurred in 47 DILI patients,and the top three drugs that caused liver failure were traditional Chinese medicine or Chinese patent medicine(29.8%),non-steroidal anti-inflammatory drugs(23.4%),and anti-infective drugs(19.1%).(2)The clinical symptoms of DILI are nonspecific,and the common ones were jaundice(56.7%),anorexia(50.4%),and fatigue(44.7%).The most common complication of drug-induced liver failure(DILF)was water-electrolyte disorder(66.0%),followed by hepatic encephalopathy(48.9%)and infection of various parts(29.8%).(3)Univariate analysis showed that DILI patients with hepatocellular or cholestatic types were more likely to develop liver failure than patients with mixed type(P=0.019).And compared with the non-hepatic failure group,the liver failure group had a lower body mass index(P=0.013),more underlying liver disease(P=0.000),more patients from other urban areas in Guangdong province(P=0.003),higher white blood cells(P=0.008),higher eosinophils(P=0.019),lower platelets(P=0.000),higher C-reactive protein(P=0.000),higher alanine aminotransferase(P=0.001),higher aspartate aminotransferase(P=0.000),higher cystatin C(P=0.000),lower albumin(P=0.000),lower uric acid(P=0.022),lower serum natrium(P=0.000),lower cholinesterase(P=0.000),lower total cholesterol(P=0.000),lower high density lipoprotein-cholesterol(P=0.000),lower low density lipoprotein-cholesterol(P=0.000),lower apolipoprotein A(P=0.000),lower apolipoprotein B(P=0.008),higher alpha-fetoprotein(P=0.000)and CA199(P=0.000).(7)Logistic multivariate analysis showed that combination with underlying liver disease,platelets(P=0.013),apolipoprotein A(P=0.000),CA199(P=0.045)and alanine aminotransferase(P=0.008)were selected into the regression model.When the cut-off value of apolipoprotein A was 0.615g/L,the sensitivity and specificity for predicting liver failure in DILI were 91.5% and80.9%,respectively.Conclusion:(1)DILI was more common in middle-aged and elderly men in this study.About 50% of DILI patients were caused by traditional Chinese medicines or Chinese patent medicines and NSAIDs,and 1/3(47/141)of DILI patients developed liver failure.(2)Combination of underlying liver disease was an independent risk factor for liver failure in DILI.Platelets,apolipoprotein A,CA199 and alanine aminotransferase could be used as independent predictors of liver failure in DILI.There were high sensitivity and specificity to predicting liver failure in DILI,when the cut-off value of apolipoprotein A is 0.615g/L.