Evaluation Of Prognostic Markers In Severe Drug-Induced Liver Disease

Background & AimsProgress in the understanding of susceptibility factors to drug-induced liver disease (DILD) and outcome predictability are hampered by the lack of systematic programs to detect bona fide cases. The aim of this study was to analyze the outcome of patients with severe DILD and evaluate the most important predictors for outcome. MethodsThe data of the patients suspicious of DILD in our hospital are collected since 1997 following a structured form and input in the computer. The liver damage was characterized according tohepatocellular, cholestatic, and mixed laboratory criteria and to histologic criteria when available. Further evaluation of causality assessment was centrally performed. ResultsSince January 1997 to December 2004, 265 patients were deemed to be related to DILD , of which 140(52.8%) were female. The hepatocellular pattern of damage was the most common (72.1%), the incidence of death in this group was 9.9% , whereas the corresponding figure was 9.5% in cholestatic/mixed patients (P <0 .05). There were no difference between the age of the died patients and those who recovered. The proportion of females and males was similar in those who recovered and in those who died and no difference was observed in duration of treatment in the two groups. Deceased patients had higher serum total bilirubin(P<0.001)direct bilirubin(P<0.001)and AST(P=0.013) values than surviving patients. Chinese herbal medicine was the more frequently incriminated, it accounting for the 24.2% of the whole series. However,antituberculous drugs(3.4%) are the primary etiological factor of fetal DILDs .Factors associated with the development of fulminant hepatic failure were as following: hepatic encephalopathy (OR= 43.66;95% CI: 8.47-224.95;P<0.0001),ascite (OR=28.48;95% CI: 9.26-87.58;P <0 .0001), jaundice(OR=11.43;95% CI: 1.52-85.96;P=0.003), alcohol abuse(OR=3.83;95% CI: 1.26-11.67;P=0.035) and direct bilirubin (OR =1.93;95% CI: 1.25-2.58;P =0 .012). ConclusionsPatients with drug-induced liver disease have 9.8% chance of progressing to death. Chinese herbal medicine stands out as the most common drug related to DILD.While antituberculous drugs are the primary etiological factor of fetal DILDs. Hepatic encephalopathy, ascite , jaundice , alcohol abuse and direct bilirubin levels are associated with the death of the patients with DILD.