Worland Thomas, Chin Ken Lee, Rodrigues Beverley, Nicoll Amanda
Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia.
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Transl Gastroenterol Hepatol. 2020 Jul 5;5:33. doi: 10.21037/tgh.2019.10.15. eCollection 2020.
Identification of risk factors for drug-induced liver injury (DILI) has been hindered by the unpredictable incidence and idiosyncratic nature of DILI. The aim of this study was to identify characteristic host risk factors for DILI.
A retrospective cohort study was performed examining all patients admitted with a diagnosis of DILI over a 5.5-year period. Cases were compared to a control group non-exposed to DILI using propensity score-derived inverse probability weights. Patients with DILI due to alcohol or paracetamol were excluded from analysis.
Seventy-two cases of DILI admitted to hospital were identified. Antimicrobials caused 56.9% of cases, with amoxicillin-clavulanate the single most common agent, responsible for 13.9% of cases. DILI cohort median age (50.2±36 years) was significantly younger than controls (65.0±38 years) (P<0.001). Pre-existing chronic liver disease (OR, 3.44; 95% CI, 1.38-8.59; P=0.008), length of stay (P<0.001) and in-hospital death (P=0.009) were more likely to be associated with DILI cases. There was no correlation with sex (OR male, 0.92; 95% CI, 0.50-1.67; P=0.78), presence of comorbid autoimmune disease (OR, 1.44; 95% CI, 0.68-3.05; P=0.35), past drug allergies (OR, 1.71; 95% CI, 0.92-3.16; P=0.09), or atopy (OR, 0.87; 95% CI, 0.42-1.82; P=0.72).
Younger age and presence of chronic liver disease were associated with an admission with DILI; however, it remains difficult to predict the population at risk of DILI on clinical grounds and putative risk factors such as female gender, and history of other drug allergies and autoimmunity, were not demonstrated in this study.
药物性肝损伤（DILI）的不可预测发病率和特异质性阻碍了其危险因素的识别。本研究的目的是识别DILI的特征性宿主危险因素。
进行了一项回顾性队列研究，检查了在5.5年期间所有诊断为DILI的住院患者。使用倾向评分衍生的逆概率权重将病例与未暴露于DILI的对照组进行比较。因酒精或对乙酰氨基酚导致DILI的患者被排除在分析之外。
共识别出72例住院的DILI病例。抗菌药物导致了56.9%的病例，其中阿莫西林-克拉维酸是最常见的单一药物，占病例的13.9%。DILI队列的中位年龄（50.2±36岁）显著低于对照组（65.0±38岁）（P<0.001）。既往存在慢性肝病（OR，3.44；95%CI，1.38-8.59；P=0.008）、住院时间（P<0.001）和院内死亡（P=0.009）更可能与DILI病例相关。与性别（男性OR，0.92；95%CI，0.50-1.67；P=0.78）、合并自身免疫性疾病（OR，1.44；95%CI，0.68-3.05；P=0.35）、既往药物过敏（OR，1.71；95%CI，0.92-3.16；P=0.09）或特应性（OR，0.87；95%CI，0.42-1.82；P=0.72）均无相关性。
年轻和存在慢性肝病与DILI住院相关；然而，基于临床依据预测DILI风险人群仍然困难，本研究未证实诸如女性性别、其他药物过敏史和自身免疫等假定危险因素。
