Clinical Features Of Drug-Induced Liver Injury

ObjectiveTo analyze clinical characteristics of drug-induced liver injury(DILI) patients, including some drug-related liver failure patients, in order to improve the clinical understanding of DILI, thus to guide the clinical work.MethodsA retrospective analysis of the first clinical diagnosis of159patients with drug-induced liver injury or drug-induced hepatitis and without other liver diseases including alcoholic,viral and autoimmune liver diseases was performed between July2006to June2012. Among159patients,there were17patients with drug-induced liver failure. Clinical characteristics of these patients were retrospectively analyzed, including gender, age, medications,clinical manifestations, DILI type,days of hospitalization, biochemical parameters, immunological indicators, pathology features and therapy,etc.The data with normal distribution are presented as mean±SD, comparison between two groups was made using Student’s t testComparison between two groups of nonparametric statistics was using Mann-Whitney rank. Comparison of categorical data between groups were made by X2test or Fisher’s test. A P value less than0.05was considered significant.ResultsThere were57males and102females among159patients, with aged18-82years old, on average (50.8±14.1) years. Chinese herbal medicine (66.0%) was the most common cause, followed by antibiotics (8.8%), chemotherapy drugs (4.4%), unknown causes (4.4%), anti-tuberculous drug (3.8%), health care products (3.1%), analgesic-antipyretic (2.5%), glucocorticoids (1.3%), drug for nervous diseases (1.3%), medicines for lowering blood pressure and lipid (1.3%), antithyroid drugs (1.3%), sex hormones (0.7%). Among the159patients,135patients received single drug(76.7%) and37patients received combination drugs (23.31%). The disease was mainly attacked at summer and autumn (61.4%), the winter was less (16%). The mainly clinical manifestations were feeble (41.5%), gastrointestinal symptoms (63.5%), dark urine (82.4%), fever (7.5%), erythra and itching (6.9%), and1patient had no symptom. There were38patients with ANA-positive (23.9%) among the159patients. Among the19patients whose liver biopsy was performed, the pathology features were as follows:14patients with cholestasis,8patients with liver cell degeneration (ballooning degeneration and acidophilic degeneration),14patients with spotted and focal necrosis,2patients with piecemeal necrosis,1patient with large patchy necrosis,4patients with fibroplasia,14patients with lymphocytes or mixed cell infiltration,2patients with apoptotic body,1patient with infiltration of eosinophilis and1patient with granuloma and pigmentation. Clinical DILI types:104patients presented with hepatocellular (65.4%),21patients with cholestatic (13.2%) and34patients with mixed (21.4%). The patients presented with hepatocellular injury type had a higher level of ALT and AST, and the patients presented with cholestatic injury type had a higher level of ALP and total bilirubin. Liver failure were found in17cases (10.7%), and4patients died.ConclusionsDrug-induced liver injury is more common in women and elder persons. Herbal medicine, antibacterial drugs, chemotherapy drugs were most common cause in these DILI patients. The mainly pathological type was hepatocellular. The majority had a good prognosis after treatment, but poor prognosis for Drug-induced liver failure.