The Clinical Features And Prognosis Analysis Of 268 Patients With Drug-Induced Liver Injury

Objective:To analyze the etiology,clinical features and prognosis of drug-induced liver injury(DILI)in recent three years and to enhance the level of diagnosis and treatment of DILI.Methods:A retrospective analysis was conducted on the clinical data of the 268 patients with DILI from the The First Affiliated Hospital of Nanjing Medical University from January 2013 to December 2016.Patients information were collected including demographic characteristics,drug history,clinical manifestation and classification,laboratory examination,liver histopathology,complications,treatment and the factors related with prognosis.SPSS 22.0 software was used for statistical analysis.Results:A total of 268 patients was analyzed.The male female ratio was 1:1.68.The mean age of the patients was 52.24± 13.82 years.The highest incidence of age was 41 to 59 years old.The first five drugs were chinese herbal medicine(64.7%),anti-thyroid drugs(5.2%),anti-tuberculosis drugs(4.8%),antitumor drugs(4.8%) and antibiotics(3.7%).The common symptom was fatigue?anorexia?abdominal distension and other systemic and gastrointestinal symptoms,some patients may be missing.The most common clinical type was hepatitic(61.9%)followed by mixed(18.3%)and cholestatic(11.9%),the least was hepatic vascular injury(7.8%).Demographic characteristics showed that women and elderly patients were more common.Use ANOVA and Chi-square test analysis found that elderly patients were susceptible to cholestatic and hepatic vascular injury,female patients were easy suffering from hepatitic(70.2%).Liver damage degree of 3 to 5 accounted for 63.5%.Of the 268 patients,48 patients(17.9%)were cured,198 patients(73.9%)were improved,10 patients(3.7%)were worsened and 12 patients(4.5%)were dead.Univariate analysis showed that female?age?ALT?ALB?PT?APTT?INR?the type of hepatic vascular injury?spontaneous bacterial peritonitis and hepatic encephalopathy were factors related with poor prognosis.Multivariate analysis showed that ALT(P?0.010,OR?0.992)?ALB(P=0.002,OR=0.900)?PT(P=0.018,OR=l.867)were independent factors with poor prognosis.Conclusion:DILI showed a trend of severe,female and elderly patients were more common.Many drugs can cause drug-induced liver injury and chinese herbal medicine was mainly in our country.Elderly patients were susceptible to cholestatic and hepatic vascular injury and female patients were more prone to hepatitic.Clinical manifestations were of lack of specificity,some patients may be missing.The overall prognosis of DILI was better and ALT,ALB and PT were independent predictors of poor prognosis.