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Idiosyncratic drug-induced liver injury is associated with substantial mortality

Idiosyncratic drug-induced liver injury is associated with substantial morbidity and mortality within 6 months from onset, reports the latest issue of Gastroenterology.

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Little is known about the incidence of drug-induced liver injury (DILI) and risk factors for adverse outcomes.

Dr Robert Fontana and colleagues from Michigan, USA evaluated short-term outcomes of a large cohort of patients with drug-induced liver injury enrolled in an ongoing multicenter prospective study.

Data were collected from 660 adults with definite, highly likely, or probable drug-induced liver injury.

Regression methods were used to identify risk factors for early liver-related death or liver transplantation and chronic liver injury.

The team found that the patients' median age was 51 years, and 60% were female with 59% requiring hospitalization.

19% of the 598 evaluable subjects had persistent liver damage
Gastroenterology

Within 6 months of drug-induced liver injury onset, 30 patients received liver transplants, and 32 died.

The team found that 53% of the deaths were liver related.

Asian race, absence of itching, lung disease, low serum albumin levels, low platelet counts, and high serum levels of alanine aminotransferase and total bilirubin at presentation were independent risk factors for reduced times to liver-related death or liver transplantation.

At 6 months after drug-induced liver injury onset, 19% of the 598 evaluable subjects had persistent liver damage.

The researchers observed that African-American race, higher serum levels of alkaline phosphatase, and prior heart disease or malignancy requiring treatment were independent risk factors for chronic drug-induced liver injury.

Dr Fontana's team commented, "Nearly 1 in 10 patients die or undergo liver transplantation within 6 months of drug-induced liver injury onset, and nearly 1 in 5 of the remaining patients have evidence of persistent liver injury at 6 months."

"The profile of liver injury at presentation, initial severity, patient's race, and medical comorbidities are important determinants of the likelihood of death/transplantation or persistent liver injury within 6 months."

Gastroenterology 2014: 147(1): 96–108.e4
30 June 2014

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