A clinical observation and analysis of 122 cases of acute and chronic drug-induced liver injuries

Abstract

Abstract: Objective To analyze the clinical features and prognosis of acute and chronic drug induced liver injuries (DILI). Methods A total of 122 patients with DILI from January 2015 to December 2021 were included, including 79 males and 43 females, with an average age of 50 (38, 68) years old. According to the courses of diseases, the patients were divided into acute DILI (n=101) and chronic DILI (n=21) groups. The diagnosis of DILI meets the Chinese guideline for the diagnosis and treatment of DILI. The etiologies, clinical features, and clinical outcomes of acute and chronic DILI patients were compared. Results The causes of acute and chronic DILI were similar. The main causative drugs included Chinese patent medicines (78 cases, 63.9%), antibacterial drugs (15 cases, 12.3%) analgesic and antipyretic drugs (13 cases, 10.6%). Comparing the clinical features of acute and chronic DILI patients, the platelet (PLT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) of acute DILI patients were 212 (104, 376) ×10⁹/L, 276 (29, 711) U/L and 168 (18, 643) U/L, which were significantly higher than those of chronic DILI [162 (84, 235) ×10⁹/L, 80 (12, 318) U/L and 114 (10, 307) U/L, P<0.05]. the positive rates of anti-nuclear antibody (ANA) and anti-smooth muscle actin antibody (SMA) in acute DILI patients were 38 cases (37.6%) and 4 cases (4.0%), respectively, which were significantly lower than those in chronic DILI [13 cases (61.9%) and 4 cases (19.0%), P<0.05]. By analyzing the clinical outcomes of acute and chronic DILI patients, the incubation period of acute DILI patients [32 (2, 150) days] was significantly shorter than that of chronic DILI patients [44 (12, 260) days, P<0.05]. 9 cases (8.9%) and 1 case (1.0%) of patients with acute DILI were treated with steroid hormone or steroid plus immunosuppressant, and the difference was statistically significant (P<0.05) when compared with those of 8 cases (38.1%) and 5 cases (23.8%) of chronic DILI. Conclusion The causative drugs for acute and chronic DILI are similar, mainly including Chinese patent medicine, antibacterial drugs, analgesic and antipyretic drugs. Compared with acute DILI, patients with chronic DILI have severe liver enzyme abnormalities and longer latent periods, with requirement of adjuvant treatment by steroids and immunosuppressants to improve the patients' clinical outcome.

Key words: Drug-induced liver injury, Chinese patent drug, Immune inhibitor

GE Wen-jun, LIU Jun, REN Jun. A clinical observation and analysis of 122 cases of acute and chronic drug-induced liver injuries[J]. Chinese Hepatolgy, 2023, 28(3): 343-345.

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