Fang Wendy C, Adler Nikki R, Graudins Linda V, Goldblatt Caitlin, Goh Michelle S Y, Roberts Stuart K, Trubiano Jason A, Aung Ar Kar
Department of Medicine, Alfred Health, Melbourne, Victoria, Australia.
Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.
Intern Med J. 2018 May;48(5):549-555. doi: 10.1111/imj.13734.
Drug-induced liver injury (DILI) can be associated with certain cutaneous adverse drug reaction (cADR).
To demonstrate the prevalence of DILI in patients with cADRs. Severity and patterns of liver injury, risk factors, causal medications and outcomes are also examined.
A retrospective cohort study of patients with cADRs was conducted across two hospitals in Australia. Patients were identified through cross-linkage of multiple databases.
One hundred and four patients with cADRs were identified. Of these, 33 (31.7%) had liver injury, representing 50% of patients with drug reaction with eosinophilia and systemic symptoms, and 30.2% of patients with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). Most cases of liver injury (69.7%) were of a cholestatic/mixed pattern with severe disease in 18.2%. No significant risk factors for development of liver injury were noted, but peripheral lymphocytosis may represent a risk in patients with SJS (odds ratio, OR = 6.0, 95% confidence interval, CI: 1.8-19.7, P = 0.003). Antimicrobials were the most common class to be implicated in DILI. The median length of inpatient stay was longer in patients with liver injury compared to those without (19 vs 11 days, P = 0.002). The mortality rate in those with liver injury was 15.2% and 9.9% in those without. No patients required liver transplantation.
DILI commonly occurs in patients with cADRs and is associated with longer inpatient stay. Patients with SJS/TEN and peripheral lymphocytosis appear to be at higher risk for developing associated liver injury.
药物性肝损伤（DILI）可能与某些皮肤药物不良反应（cADR）相关。
证明cADR患者中DILI的患病率。同时还研究肝损伤的严重程度和模式、危险因素、致病药物及转归。
在澳大利亚的两家医院对cADR患者进行了一项回顾性队列研究。通过多个数据库的交叉关联识别患者。
共识别出104例cADR患者。其中，33例（31.7%）出现肝损伤，占伴有嗜酸性粒细胞增多和全身症状的药物反应患者的50%，以及史蒂文斯-约翰逊综合征（SJS）/中毒性表皮坏死松解症（TEN）患者的30.2%。大多数肝损伤病例（69.7%）为胆汁淤积性/混合型，18.2%为重症。未发现肝损伤发生的显著危险因素，但外周淋巴细胞增多可能是SJS患者发生肝损伤的一个危险因素（比值比，OR = 6.0，95%置信区间，CI：1.8 - 19.7，P = 0.003）。抗菌药物是DILI中最常见的致病药物类别。与无肝损伤患者相比，肝损伤患者的住院中位时间更长（19天对11天，P = 0.002）。肝损伤患者的死亡率为15.2%，无肝损伤患者为9.9%。无患者需要肝移植。
DILI常见于cADR患者，且与住院时间延长相关。SJS/TEN和外周淋巴细胞增多的患者发生相关肝损伤的风险似乎更高。
