Drug-induced liver failure:clinical analysis of 108 cases
10.3760/cma.j.issn.1008-5734.2018.03.003
- VernacularTitle:药物性肝衰竭108例临床分析
- Author:
Lijun WANG
1
;
Hanqiu ZHAN
1
Author Information
1. 100015,首都医科大学附属北京地坛医院药剂科
- Publication Type:Journal Article
- Keywords:
Drug-induced liver injury;
Liver failure;
Disease attributes
- From:
Adverse Drug Reactions Journal
2018;20(3):169-175
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the etiology,clinical features and outcome of drug-induced liver failure (DILF)for reference to safe drug use in clinical practice. Methods The information of patients with DILF,who were admitted to the Department of Liver Disease in Beijing Ditan Hospital Capital Medical University from January 1,2007 to December 31,2016 was collected using hospital information system and analyzed retrospectively. Results A total of 108 patients were entered investigation,including 46 males (42.6% )and 62 females (57.4% ),aged 11 to 81 years with a median age 48 (35,61)years. Of the 108 patients with DILF,48 patients (44.4% )received Western medicines,43 patients (39.8% )received traditional Chinese medicines,13 patients (12.0% )received Western medicines combined with traditional Chinese medicines,and 4 patients (3. 7% )received medicines with no definite classifications. In 61 patients receiving Western medicines or Western medicines plus traditional Chinese medicines,the top 3 Western medicines were antituberculosis drugs (29. 5% ,18/61 ),nonsteroidal anti-inflammatory drugs (18.0% ,11/61)and anti-infective agents except antituberculosis drugs (14.7% ,9/61). Of 56 patients receiving traditional Chinese medicines or traditional Chinese medicines plus Western medicines,15 had osteoarthrosis,15 had skin diseases(53.6% in total,30/56). Ten patients had no definite diseases,who only took traditional Chinese medicine for recuperation or health care,accounting for 23.3% of the 43 patients receiving traditional Chinese medicines. Among the 108 DILF patients,44 patients (40.7% )were diagnosed as having subacute liver failure,41 patients(38% )as acute liver failure,21 patients(19.4% ) as acute-on-chronic liver failure,and 2 patients (1. 9% ) as chronic liver failure;according to their pathologic features,66 patients(63.4% )had hepatocyte liver injury,6 patients(5.8% )had cholestasis liver injury,and 32 patients (30.8% )had mixed type liver injury. The length of hospitalization of 108 patients was 1-183 days,and the medium length of hospitalization was 22 (10,44)days. In addition,33 patients (30.6% )died during their hospitalization,3 patients (2. 8% )were judged to be cured,40 patients(37.0% )were improved,and 32 patients(29.6% )were invalid at the time of their discharge. The MELD scores of patients in the effective treatment group (cure and improvement)and ineffective treatment group (ineffectiveness and death)were (24.2 ± 6.7)and (36.4 ± 12.3),respectively. And the difference was statistically significant(t＝ －5.9245,P＜0.001). A MELD score cut-off values of≥32.3 (sensitivity 60.0% ,specificity 93. 0% )was determined as having invalid or death risk for patients with DILF. Conclusions Western medicines that might induce liver failure mainly include anti-infective drugs (especially antituberculous drugs)and nonsteroidal anti-inflammatory drugs. Traditional Chinese medicines and their preparations as well as heath care products were also an important cause of DILF. The major pathological features of DILF were hepatocyte liver injury. The prognosis of patients with DILF is poor. MELD score might be used to predict the prognosis of DILF.
