基于综合医疗保健系统分析的药物性急性肝衰竭的人群代表性发病率
Population-representative incidence of drug-induced acute liver failure based on an analysis of an integrated health care system.
作者信息
Goldberg David S, Forde Kimberly A, Carbonari Dean M, Lewis James D, Leidl Kimberly B F, Reddy K Rajender, Haynes Kevin, Roy Jason, Sha Daohang, Marks Amy R, Schneider Jennifer L, Strom Brian L, Corley Douglas A, Lo Re Vincent
机构信息
Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
Gastroenterology. 2015 Jun;148(7):1353-61.e3. doi: 10.1053/j.gastro.2015.02.050. Epub 2015 Feb 28.
BACKGROUND & AIMS: Medications are a major cause of acute liver failure (ALF) in the United States, but no population-based studies have evaluated the incidence of ALF from drug-induced liver injury. We aimed to determine the incidence and outcomes of drug-induced ALF in an integrated health care system that approximates a population-based cohort.
METHODS
We performed a retrospective cohort study using data from the Kaiser Permanente Northern California (KPNC) health care system between January 1, 2004, and December 31, 2010. We included all KPNC members age 18 years and older with 6 months or more of membership and hospitalization for potential ALF. The primary outcome was drug-induced ALF (defined as coagulopathy and hepatic encephalopathy without underlying chronic liver disease), determined by hepatologists who reviewed medical records of all KPNC members with inpatient diagnostic and laboratory criteria suggesting potential ALF.
RESULTS
Among 5,484,224 KPNC members between 2004 and 2010, 669 had inpatient diagnostic and laboratory criteria indicating potential ALF. After medical record review, 62 (9.3%) were categorized as having definite or possible ALF, and 32 (51.6%) had a drug-induced etiology (27 definite, 5 possible). Acetaminophen was implicated in 18 events (56.3%), dietary/herbal supplements in 6 events (18.8%), antimicrobials in 2 events (6.3%), and miscellaneous medications in 6 events (18.8%). One patient with acetaminophen-induced ALF died (5.6%; 0.06 events/1,000,000 person-years) compared with 3 patients with non-acetaminophen-induced ALF (21.4%; 0.18/1,000,000 person-years). Overall, 6 patients (18.8%) underwent liver transplantation, and 22 patients (68.8%) were discharged without transplantation. The incidence rates of any definite drug-induced ALF and acetaminophen-induced ALF were 1.61 events/1,000,000 person-years (95% confidence interval, 1.06-2.35) and 1.02 events/1,000,000 person-years (95% confidence interval, 0.59-1.63), respectively.
CONCLUSIONS
Drug-induced ALF is uncommon, but over-the-counter products and dietary/herbal supplements are its most common causes.
背景与目的
在美国，药物是急性肝衰竭（ALF）的主要病因，但尚无基于人群的研究评估药物性肝损伤所致ALF的发病率。我们旨在确定在一个近似基于人群队列的综合医疗保健系统中药物性ALF的发病率及转归。
方法
我们利用北加利福尼亚凯撒医疗集团（KPNC）医疗保健系统2004年1月1日至2010年12月31日的数据进行了一项回顾性队列研究。纳入所有年龄在18岁及以上、会员资格达6个月或更长时间且因潜在ALF住院的KPNC会员。主要结局为药物性ALF（定义为无潜在慢性肝病的凝血功能障碍和肝性脑病），由肝病专家根据所有有住院诊断及实验室标准提示潜在ALF的KPNC会员的病历进行判定。
结果
2004年至2010年间，在5484224名KPNC会员中，669人有住院诊断及实验室标准提示潜在ALF。经病历审查，62人（9.3%）被归类为确诊或可能患有ALF，32人（51.6%）有药物性病因（27例确诊，5例可能）。对乙酰氨基酚与18例事件（56.3%）有关，膳食/草药补充剂与6例事件（18.8%）有关，抗菌药物与2例事件（6.3%）有关，其他药物与6例事件（18.8%）有关。1例对乙酰氨基酚所致ALF患者死亡（5.6%；0.06例/100万人年），而3例非对乙酰氨基酚所致ALF患者死亡（21.4%；0.18/100万人年）。总体而言，6例患者（18.8%）接受了肝移植，22例患者（68.8%）未接受移植出院。任何确诊的药物性ALF和对乙酰氨基酚所致ALF的发病率分别为1.61例/100万人年（95%置信区间，1.06 - 2.35）和1.02例/100万人年（95%置信区间，0.59 - 1.63）。
结论
药物性ALF并不常见，但非处方产品及膳食/草药补充剂是其最常见病因。
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