Epidemiology Of Drug-induced Liver Injury In China: A Systematic Analysis Of The Chinese Literature Including21789Patients

BackgroundThe epidemiology of drug-induced liver injury (DILI) in China has rarely been studiedbefore. The aim of the present study was to determine the etiology of DILI in a Chinesepopulation by reporting a systematic analysis of Chinese literature published from1994to2011.MethodsThe search was performed in September2011and combined three electronic databases,including the Chongqing VIP Database (1994–2011), the China Bio-medical Disk Database(1994–2011), and the China Journal Full-Text Database (1994–2011). Furthermore, manualsearches were performed in the Zhong Hua Xiao Hua Za Zhi (Chinese Journal of Digestion)and the Zhong Hua Gan Zang Bing Za Zhi (Chinese Journal of Hepatology).Two of the authors independently selected the trials to be included in the review on thebasis of the prespecified eligibility criteria. Disagreements were resolved by discussion; ifthis process did not solve a disagreement, a third author (Dr. Hong Guo) was consulted. Thedecisions for inclusion and exclusion were made on the basis of the entire content of thestudies (if available), and data from the included studies were recorded on a speciallydeveloped form.ResultsIn this research, we found279studies, including24112patients. There were265studies that reported sex of21789patients,11787men and10002women. Thetherapeutics included (but not limited to)tuberculostatics, complementary and alternativemedicines, antibiotics, NSAIDs, antineoplastics, central nervous system agents, antithyroid drugs, and immunomodulators. Tuberculostatics was the most common etiology of DILI inChina.In total,1119reports were identified. After reviewing the titles and abstracts,840reports were excluded and279reports were included for review. The comprehensiveliterature search yielded279original reports, and these reports detailed the clinical eventsin273different hospitals in25provinces and in four municipalities that were directly underthe jurisdiction of the central government. The sample size of these reports ranged from30to670patients, and the overall number of patients included was24112. The basiccharacteristics of these279original reports are shown in Table1. Among the informationrecorded,265studies reported the sex of21789patients,11787(54.1%) men and10002(45.9%)women, with a male to female ratio of1.2:1. Of24112cases, the sex of2323patients was not reported. The ages of the patients ranged from3months to94years. Onehundred and ninety-nine articles reported the average age of their patients; in77.9%(155/199) of the publications, the average age of the patients was more than40years.In addition, mortality was2.9%ConclusionDILI in China has a different etiology thanin Europe and USA. NSAIDs, which are the most common causes of DILI in westernpopulations, are uncommon in China. Consequently, government, physicians, and patientsshould pay more attention to these drugs in DILI.