Drug-Induced Acute-on-Chronic Liver Failure in Asian Patients
| Autor: | Harshad Devarbhavi, Manish Sharma, Mamun Al Mahtab, Salimur Rahman, Samir Shah, Jose D. Sollano, Chandan Kumar Kedarisetty, Yogesh Chawla, Priyanka Jain, George K. K. Lau, Chetan Kalal, Chundamannil E. Eapen, Rakhi Maiwall, P Nagaraja Rao, Jinhua Hu, Akash Shukla, Osamu Yokosuka, Puja Bhatia, Hasmik Ghazinian, Man-Fung Yuen, Ashish Goel, Zhongping Duan, Manoj Kumar Sahu, Sunil Taneja, Ajit Sood, Sombat Treeprasertsuk, Laurentius A. Lesmana, Chen Yu, Dong Joon Kim, Wasim Jafri, Vandana Midha, Saeed Hamid, Ajay Duseja, Amna Subhan Butt, Shiv Kumar Sarin, Qin Ning, Zaigham Abbas, Radha K. Dhiman, Soek Siam Tan, Seng Gee Lim, Vivek A. Saraswat, D.A. Payawal, Ashok Choudhury, A. Kadir Dokmeci, Cosmas Rinaldi Adithya Lesmana, Ananta Shrestha, Gamal Shiha, Ji Dong Jia, Guan Huei Lee, V G Mohan Prasad |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Alcoholic liver disease Asia Time Factors Adolescent Biopsy Encephalopathy Gastroenterology Young Adult 03 medical and health sciences Liver disease 0302 clinical medicine Internal medicine Ascites Humans Medicine Decompensation Prospective Studies Prospective cohort study Aged Hepatology business.industry Acute-On-Chronic Liver Failure Middle Aged Jaundice Prognosis medicine.disease Survival Rate Liver 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Chemical and Drug Induced Liver Injury Morbidity medicine.symptom Steatohepatitis business Follow-Up Studies |
| Zdroj: | American Journal of Gastroenterology. 114:929-937 |
| ISSN: | 1572-0241 0002-9270 |
| Popis: | OBJECTIVES Acute insults from viruses, infections, or alcohol are established causes of decompensation leading to acute-on-chronic liver failure (ACLF). Information regarding drugs as triggers of ACLF is lacking. We examined data regarding drugs producing ACLF and analyzed clinical features, laboratory characteristics, outcome, and predictors of mortality in patients with drug-induced ACLF. METHODS We identified drugs as precipitants of ACLF among prospective cohort of patients with ACLF from the Asian Pacific Association of Study of Liver (APASL) ACLF Research Consortium (AARC) database. Drugs were considered precipitants after exclusion of known causes together with a temporal association between exposure and decompensation. Outcome was defined as death from decompensation. RESULTS Of the 3,132 patients with ACLF, drugs were implicated as a cause in 329 (10.5%, mean age 47 years, 65% men) and other nondrug causes in 2,803 (89.5%) (group B). Complementary and alternative medications (71.7%) were the commonest insult, followed by combination antituberculosis therapy drugs (27.3%). Alcoholic liver disease (28.6%), cryptogenic liver disease (25.5%), and non-alcoholic steatohepatitis (NASH) (16.7%) were common causes of underlying liver diseases. Patients with drug-induced ACLF had jaundice (100%), ascites (88%), encephalopathy (46.5%), high Model for End-Stage Liver Disease (MELD) (30.2), and Child-Turcotte-Pugh score (12.1). The overall 90-day mortality was higher in drug-induced (46.5%) than in non-drug-induced ACLF (38.8%) (P = 0.007). The Cox regression model identified arterial lactate (P < 0.001) and total bilirubin (P = 0.008) as predictors of mortality. DISCUSSION Drugs are important identifiable causes of ACLF in Asia-Pacific countries, predominantly from complementary and alternative medications, followed by antituberculosis drugs. Encephalopathy, bilirubin, blood urea, lactate, and international normalized ratio (INR) predict mortality in drug-induced ACLF. |
| Databáze: | OpenAIRE |
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