Analysis on occurrence and risk factors of drug-induced liver injury in patients with novel coronavirus pneumonia
10.3760/cma.j.cn114015-20200331-00322
- VernacularTitle:新型冠状病毒肺炎患者药物性肝损伤发生情况及其危险因素分析
- Author:
Xuanyu DENG
1
;
Juanjuan HUANG
1
;
Ji SUN
1
;
Shiqiong HUANG
1
;
Yanfei LI
1
;
Gefei HE
1
Author Information
1. 长沙市第一医院药剂科 410005
- Publication Type:Journal Article
- Keywords:
Coronavirus infections;
Chemical drug induced liver injury;
Drug-related side effects and adverse reactions;
Risk factors
- From:
Adverse Drug Reactions Journal
2020;22(6):360-365
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the occurrence and risk factors of drug-induced liver injury (DILI) in patients with novel coronavirus pneumonia (COVID-19).Methods:The medical records of patients with COVID-19 who were discharged from the First Hospital of Changsha from January 15 to March 7, 2020 were collected and the patients were divided into the DILI group and the non-DILI group based on DILI diagnostic criteria. Basic information of patients in the 2 groups including gender, age, underlying diseases, classification of COVID-19, liver function test results on admission and after medication, drug use, time to DILI onset after medication, and treatments and outcomes of DILI were recorded and compared. The incidence of DILI in patients with COVID-19 was calculated, and the factors whose P<0.05 in inter-group comparison were included in the multivariate logistic regression analysis to calculate the odds ratio ( OR) and95% confidence interval ( CI). Results:A total of 203 discharged patients with COVID-19 met the inclusion criteria. Of them, 36 patients developed DILI, the incidence was 17.73%. Between the DILI group and the non-DILI group (167 patients), the differences were statistically significant in gender distribution, proportion of patients with underlying diseases such as hypertension, fatty liver, and cholelithiasis, clinical classification of COVID-19, and the kinds of drug use ( P<0.05 for all), but not statistically significant in levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil) on admission ( P>0.05 for all). The levels of ALT and AST in patients in the DILI group after medication were higher than those before medication, and the differences were statistically significant ( P<0.001 for all). The median time for time to DILI onset after medication was 8 (6, 11) days and none of the patients had obvious clinical signs and symptoms. After the occurrence of DILI, 16 patients stopped the suspicious drugs and received liver-protective treatments, 6 patients only stopped the suspicious drug without additional treatments, and 14 patients received liver-protective treatments without drug withdrawal. Among the 36 patients in the DILI group, liver function were improved in 34 patients but did not returned to normal in 2 patients when they were discharged from the hospital. Multivariate logistic regression analysis showed that male ( OR=3.939, 95 %CI: 1.426-10.883, P=0.008), being severe and critical in clinical classification ( OR=6.433, 95 %CI: 2.411-17.162, P<0.001), fatty liver ( OR=3.815, 95 %CI: 1.298-11.215, P=0.015), cholelithiasis ( OR=16.347, 95 %CI: 1.267-210.990, P=0.032), and the kinds of drug use >8 ( OR=10.181, 95 %CI: 3.606-28.744, P<0.001) were the independent risk factors of DILI in patients with COVID-19. Conclusions:The incidence of DILI in COVID-19 patients discharged from the First Hospital of Changsha is 17.73%. Male, being severe and critical in clinical classification of COVID-19, fatty liver, cholelithiasis, and the kinds of drug use >8 are the independent risk factors for DILI patients with COVID-19.
