Chiang Hsueh-Chien, Wu I-Chin
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Am J Med Sci. 2025 Feb;369(2):218-227. doi: 10.1016/j.amjms.2024.08.019. Epub 2024 Aug 23.
Drug-induced liver injury (DILI) plays an important role in liver failure and causes mortality. Patients with DILI compatible with Hy's law are associated with poorer outcomes. However, the predictive accuracy of Hy's law is not good enough in clinical practice. This study aimed to investigate the optimal values of biomarkers associated with the prognosis of DILI.
From June 1, 2014-May 30, 2022, patients with reported DILI were included. Patients' characteristics, drugs, DILI type, liver enzymes, and comorbidities were assessed. The associations with DILI-related comorbidities and survival were analyzed.
Ninety-five DILI patients were enrolled, 5 patients died of liver failure, and 23 patients died within 56 weeks after DILI. This study found that 15 mg/dL of total bilirubin, 1000 U/L of ALT, and 2 of PT-INR were optimal cut-off values in predicting DILI-related mortality. For the overall survival, patients with sepsis (HR:5.053, 95% CI:1.594-16.018, p = 0.006), malignancy (HR:4.371, 95% CI:1.573-12.147, p = 0.005), or end-stage renal disease (HR:7.409, 95% CI:1.404-39.103, p = 0.018) were independent poor prognostic factors in multivariate Cox regression analysis.
Total bilirubin >15 mg/dL, ALT >1000 U/L, and PT-INR >2 are useful biomarkers in predicting DILI-related mortality. DILI patients with sepsis, malignancy, or end-stage renal disease are associated with worse overall survival.
药物性肝损伤（DILI）在肝衰竭中起重要作用并导致死亡。符合Hy法则的DILI患者预后较差。然而，Hy法则在临床实践中的预测准确性不够好。本研究旨在探讨与DILI预后相关的生物标志物的最佳值。
纳入2014年6月1日至2022年5月30日报告的DILI患者。评估患者的特征、药物、DILI类型、肝酶和合并症。分析与DILI相关合并症和生存的关联。
纳入95例DILI患者，5例死于肝衰竭，23例在DILI后56周内死亡。本研究发现，总胆红素15mg/dL、ALT1000U/L和PT-INR2是预测DILI相关死亡率的最佳临界值。对于总生存，脓毒症患者（HR：5.053，95%CI：1.594-16.018，p=0.006）、恶性肿瘤患者（HR：4.371，95%CI：1.573-12.147，p=0.005）或终末期肾病患者（HR：7.409，95%CI：1.404-39.103，p=0.018）在多因素Cox回归分析中是独立的不良预后因素。
总胆红素>15mg/dL、ALT>1000U/L和PT-INR>2是预测DILI相关死亡率有用的生物标志物。患有脓毒症、恶性肿瘤或终末期肾病的DILI患者总生存较差。
