Chirapongsathorn Sakkarin, Sukeepaisarnjaroen Wattana, Treeprasertsuk Sombat, Chaiteerakij Roonguedee, Surawongsin Pichaporn, Hongthanakorn Chanunta, Siramolpiwat Sith, Chamroonkul Naichaya, Bunchorntavakul Chalermrat, Chotiyaputta Watcharasak, Poovorawan Kittiyod, Boonsirichan Rattana, Lawpoolsri Saranath, Sutivana Chinnavat, Sobhonslidsuk Abhasnee
Division of Gastroenterology and Hepatology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Royal Thai Army, Bangkok, Thailand.
Division of Gastroenterology and Hepatology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
J Clin Transl Hepatol. 2023 Feb 28;11(1):88-96. doi: 10.14218/JCTH.2021.00479. Epub 2022 Jun 15.
The impact of drug-induced liver injury (DILI) on patients with chronic liver disease (CLD) is unclear. There are few reports comparing DILI in CLD and non-CLD patients. In this study, we aimed to determine the incidence and outcomes of DILI in patients with and without CLD.
We collected data on eligible individuals with suspected DILI between 2018 and 2020 who were evaluated systematically for other etiologies, causes, and the severity of DILI. We compared the causative agents, clinical features, and outcomes of DILI among subjects with and without CLD who were enrolled in the Thai Association for the Study of the Liver DILI registry. Subjects with definite, or highly likely DILI were included in the analysis.
A total of 200 subjects diagnosed with DILI were found in the registry. Of those, 41 had CLD and 159 had no evidence of CLD in their background. Complementary and alternative medicine (CAM) products were identified as the most common class of DILI agents. Approximately 59% of DILI in the CLD and 40% in non-CLD group were associated with CAM use. Individuals with pre-existing CLD had similar severity including mortality. Twelve patients (6%) developed adverse outcomes related to DILI including seven (3.5%) deaths and five (2.5%) with liver failure. Mortality was 4.88% in CLD and 3.14% in non-CLD subjects over median periods of 58 (8-106) days and 22 (1-65) days, respectively.
In this liver disease registry, the causes, clinical presentation, and outcomes of DILI in subjects with CLD and without CLD patients were not different. Further study is required to confirm our findings.
药物性肝损伤（DILI）对慢性肝病（CLD）患者的影响尚不清楚。比较CLD患者和非CLD患者中DILI情况的报告较少。在本研究中，我们旨在确定有和无CLD患者中DILI的发病率及转归。
我们收集了2018年至2020年间符合疑似DILI标准的个体数据，这些个体针对其他病因、诱因及DILI严重程度进行了系统评估。我们比较了泰国肝脏研究协会DILI登记处中纳入的有和无CLD受试者之间DILI的致病因素、临床特征及转归。分析纳入确诊或高度疑似DILI的受试者。
登记处共发现200例诊断为DILI的受试者。其中，41例有CLD，159例背景中无CLD证据。补充和替代医学（CAM）产品被确定为最常见的DILI致病药物类别。CLD组中约59%的DILI和非CLD组中40%的DILI与使用CAM有关。已有CLD的个体严重程度相似，包括死亡率。12例患者（6%）出现与DILI相关的不良转归，包括7例（3.5%）死亡和5例（2.5%）出现肝衰竭。CLD组和非CLD组的死亡率分别为4.88%和3.14%，中位病程分别为58（8 - 106）天和22（1 - 65）天。
在这个肝病登记处中，有CLD和无CLD受试者中DILI的病因、临床表现及转归并无差异。需要进一步研究以证实我们的发现。
