Changes Of Cytokines And Prognostic Factors In Drug-induced Liver Failure

Purpose:To analyze the clinical characteristics of Drug induced liver failure(DILF),explore the risk factors affecting the prognosis of DILF,study the changes of inflammatory cytokines before and after artificial liver support system treatment of DILF,analyze the relationship between inflammatory cytokines and prognosis,and establish the prognosis model;It provides a new way to evaluate the efficacy of artificial liver in the treatment of DILF.Method:Data of 202 patients with DILF admitted to the Department of Infection,the First Affiliated Hospital of Nanchang University from January 2016 to December2022 were retrospectively collected,including general data,clinical data,laboratory examination and prognosis of patients at initial admission.The general characteristics,clinical characteristics and cytokines changes of DILF patients were analyzed,and the prognosis was divided into improvement group and ineffective group(worsening death).The influencing factors of prognosis were analyzed by logistic regression,and ROC curve was drawn.The prognostic model of drug-induced liver failure was established according to independent risk factors,so as to further guide clinical treatment.Results:1.The 202 patients with DILF had a mean age of 49.98 years and were mainly concentrated in the range of 41 to 80 years.There were 94 cases of males and 108 cases of females,and the ratio of males to females was roughly 1:1.14.The median time from medication to the first discovery of liver injury symptoms was 14 days,and the median length of hospital stay was 20 days.The top 5 drugs causing DILF were Chinese medicine/Chinese herbal medicine/Chinese patent medicine in 83 cases,health care products in 30 cases,anti-tuberculosis drugs in 27 cases,antipyretic and analgesic drugs in 13 cases,anti-tumor drugs in 8 cases and antibiotics in 8 cases.2.The clinical types of 202 patients with DILF were mainly hepatocyte injury type(110 cases),cholestasis type(46 cases)and mixed type(46 cases).The most common clinical manifestations on admission were jaundice,fatigue,poor appetite and abdominal distension.The most common complications were infection,electrolyte disturbance,ascites,hepatic encephalopathy and gastrointestinal bleeding.The prognosis was improved in 159 cases and invalid in 43 cases after standard treatment.3.After the treatment of artificial liver,the indexes of IL-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-12p70,IL-17,TNF-α,INF-γ,INF-αwere all decreased,the indexes of IL-10 were increased.The changes of IL-10,IL-17 and INF-αwas statistically significant(P<0.05).4.There were statistically significant differences in basic liver disease,RBC,HB,TBIL,DBIL,ALT,ALB,PLT,PT,INR,PTA,IL-2,IL-6,MELD score,infection,ascites,hepatic encephalopathy and gastrointestinal bleeding between the improved group and the ineffective(worsening death)group(P < 0.05).Multifactor analysis showed that ALT and IL-6 were independent risk factors for poor prognosis of drug-induced liver failure(P < 0.05).The prognosis model was established: logit(P)= 0.002X1-0.019X2-6.192.Among them,X1 represented ALT and X2 represented IL-6.Hosmer-Lemeshow test indicated that the model had good simulation performance(X2=4.793,P=0.779),and the area under ROC curve(AUC)of the model was 0.916(95%CI 0.856,0.976).Conclusions:1.The majority of DILF patients are middle-aged and elderly,the incidence of female is higher than that of male,and acute liver failure is the majority.The pathogenic drugs are mainly Chinese medicine/Chinese herbal medicine/Chinese patent medicine,and the main clinical manifestations are hepatocellular injury,with jaundice,fatigue,poor appetite and other manifestations as the most common manifestations.2.ALT and IL-6 are independent risk factors affecting the prognosis of DILF,and the established prognostic model of DILF has certain predictive value.