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Clinical characteristics and prognosis of non-APAP drug-induced acute liver failure: a large multicenter cohort study

Han, Lin, Huang, Ang, Chen, Jinjun, Teng, Guangju, Sun, Ying, Chang, Binxia, Liu, Hong-Li, Xu, Manman, Lan, Xiaoqin, Liang, Qingsheng, Zhao, Jun, Tian, Hui, Chen, Songhai, Zhu, Yun, Xie, Huan, Dang, Tong, Wang, Jing, Li, Ning, Wang, Xiaoxia, Chen, Yu, Yang, Yong-Feng, Ji, Dong, Zou, Zhengsheng·2024·Hepatology International
DOI 10.1007/s12072-023-10541-wPMC PMC10858105
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Abstract

Background: There is growing recognition of natural history, complications, and outcomes of patients who develop non-acetaminophen (APAP) drug-induced acute liver failure (ALF). To clarify high-risk factors and develop a nomogram model to predict transplant-free survival (TFS) in patients with non-APAP drug-induced ALF. Methods: Patients with non-APAP drug-induced ALF from 5 participating centers were retrospectively analyzed. The primary endpoint was 21-day TFS. Total sample size was 482 patients. Results: Regarding causative agents, the most common implicated drugs were herbal and dietary supplements (HDS) (57.0%). The hepatocellular type (R ≥ 5) was the main liver injury pattern (69.0%). International normalized ratio, hepatic encephalopathy grades, the use of vasopressor, N-acetylcysteine, or artificial liver support system were associated with TFS and incorporated to construct a nomogram model (drug-induced acute liver failure-5, DIALF-5). The AUROC of DIALF-5 for 7-day, 21-day, 60-day, and 90-day TFS in the internal cohort were 0.886, 0.915, 0.920, and 0.912, respectively. Moreover, the AUROC of DIALF-5 for 21-day TFS had the highest AUROC, which was significantly higher than 0.725 of MELD and 0.519 of KCC (p < 0.05), numerically higher than 0.905 of ALFSG-PI but without statistical difference (p > 0.05). These results were successfully validated in the external cohort (147 patients). Conclusions: Based on easily identifiable clinical data, the novel DIALF-5 model was developed to predict transplant-free survival in non-APAP drug-induced ALF, which was superior to KCC, MELD and had a similar prediction performance to ALFSG-PI but is more convenient, which can directly calculate TFS at multiple time points.

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Metadata

Authors
Han, L., Huang, A., Chen, J., Teng, G., Sun, Y., Chang, B., Liu, H.-L., Xu, M., Lan, X., Liang, Q., Zhao, J., Tian, H., Chen, S., Zhu, Y., Xie, H., Dang, T., Wang, J., Li, N., Wang, X., Chen, Y., Yang, Y.-F., Ji, D., & Zou, Z.
Venue
Hepatology International
Publisher
Springer Science and Business Media LLC
Published
2023-05-19
Volume
18
Issue
1
Pages
225-237
ISSN
  • 1936-0533
  • 1936-0541
DOI
10.1007/s12072-023-10541-w
PMC
PMC10858105
Cited by
9
References
5
Language
en
Licence
Funders
  • 302 Hospital Foundation (YNKTZ2018001)
  • National Natural Science Foundation of China (82070584, 81600453)
  • Beijing Nova Program (Z171100001117114)
  • Capital Characteristic Clinic Project by Beijing Municipal Science and Technology Commission (Z181100001718034)

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