Definition and risk factors for chronicity following acute idiosyncratic drug-induced liver injury
| Autor: | Medina-Caliz, Inmaculada, Robles-Diaz, Mercedes, Garcia-Muñoz, Beatriz, Stephens, Camilla, Ortega-Alonso, Aida, Garcia-Cortes, Miren, González-Jimenez, Andres, Sanabria-Cabrera, Judith A, Moreno, Inmaculada, Fernandez, M Carmen, Romero-Gomez, Manuel, Navarro, Jose M, Barriocanal, Ana M, Montane, Eva, Hallal, Hacibe, Blanco, Sonia, Soriano, German, Roman, Eva M, Gómez-Dominguez, Elena, Castiella, Agustin, Zapata, Eva M, Jimenez-Perez, Miguel, Moreno, Jose M, Aldea-Perona, Ana, Hernández-Guerra, Manuel, Prieto, Martin, Zoubek, Miguel E, Kaplowitz, Neil, Lucena, M Isabel, Andrade, Raul J, Spanish DILI registry |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Drug
medicine.medical_specialty Cirrhosis Bilirubin media_common.quotation_subject Disease Article 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Risk Factors Internal medicine medicine Humans Liver damage Prospective Studies Chronic Alanine aminotransferase media_common Liver injury Hepatology business.industry Hepatotoxicity Statins Alanine Transaminase medicine.disease Surgery Risk factors chemistry 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Chemical and Drug Induced Liver Injury business Dyslipidemia Follow-Up Studies |
| Zdroj: | J Hepatol JOURNAL OF HEPATOLOGY r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe |
| ISSN: | 0168-8278 |
| Popis: | Background & Aims: Chronic outcome following acute idiosyncratic drug-induced liver injury (DILI) is not yet defined. This prospective, long-term follow-up study aimed to analyze time to liver enzyme resolutions to establish the best definition and risk factors of DILI chronicity. Methods: 298 out of 850 patients in the Spanish DILI registry with no pre-existing disease affecting the liver and follow-up to resolution or >= 1 year were analyzed. Chronicity was defined as abnormal liver biochemistry, imaging test or histology one year after DILI recognition. Results: Out of 298 patients enrolled 273 (92%) resolved 61 year from DILI recognition and 25 patients (8%) were chronic. Independent risk factors for chronicity were older age [OR: 1.06, p = 0.011], dyslipidemia [OR: 4.26, p = 0.04] and severe DILI [OR: 14.22, p = 0.005]. Alanine aminotransferase (ALT), alkaline phosphatase (ALP) and total bilirubin (TB) median values were higher in the chronic group during follow-up. Values of ALP and TB >1.1 x upper limit of normal (xULN) and 2.8 xULN respectively, in the second month from DILI onset, were found to predict chronic DILI (p < 0.001). Main drug classes involved in chronicity were statins (24%) and anti-infectives (24%). Histological examination in chronic patients demonstrated two cases with ductal lesion and seven with cirrhosis. Conclusions: One year is the best cut-off point to define chronic DILI or prolonged recovery, with risk factors being older age, dyslipidemia and severity of the acute episode. Statins are distinctly related to chronicity. ALP and TB values in the second month could help predict chronicity or very prolonged recovery. Lay summary: Drug-induced liver injury (DILI) patients who do not resolve their liver damage during the first year should be considered chronic DILI patients. Risk factors for DILI chronicity are older age, dyslipidemia and severity of the acute episode. Chronic DILI is not a very common condition; normally featuring mild liver profile abnormalities and not being an important clinical problem, with the exception of a small number of cases of early onset cirrhosis. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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