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Single-Center Experience With Drug-Induced Liver Injury From India: Causes, Outcome, Prognosis, and Predictors of Mortality

Devarbhavi, Harshad, Dierkhising, Ross, Kremers, Walter K, Sandeep, M S, Karanth, Dheeraj, Adarsh, C K·2010·American Journal of Gastroenterology
DOI 10.1038/ajg.2010.287
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Abstract

Objectives Although drug-induced liver injury (DILI) is rare, it may result in significant morbidity or death. The causes and outcome vary according to regions, with acetaminophen and complementary medicines common in the West and the Far East, respectively. This study evaluates the causes, outcomes, predictors, and models for 90-day mortality from DILI from India. Methods Consecutive patients with DILI from 1997 to 2008 based on International Consensus Criteria from a medical college hospital setting were studied. Results Of the 313 patients, 58% were males. Leading causes were a combination of four anti-tuberculous drugs (ATDs) (58%), anti-epileptics (11%), olanzapine (5.4%), and dapsone (5.4%). The overall 90-day mortality of 17.3% was significantly higher for ATD hepatitis (21.5%) vs. those without (11.4%) (P=0.02). The highest mortality was for leflunomide (75%). Seventy-eight percent of patients received more than one drug. Fulminant hepatic failure developed more commonly in females than in males (23% vs. 17%). Of the 66% of cases with jaundice and/or icterus, mortality was 26%. Multivariable models for mortality using a combination of encephalopathy, ascites, and bilirubin, or a combination of albumin, prothrombin time, and white blood cell count yielded a C-statistic of at least 0.86 by recursive partitioning and 0.92 by logistic regression. Model for end stage liver disease (MELD) scores of 38 and 46 yield probabilities of death of 0.90 (confidence interval (CI): 0.…

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Crossref · 10.1038/ajg.2010.287

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  • The DILI fatality rate in our study was much lower than has been observed in other registries.

    “It is therefore interesting that the DILI fatality rate in our study was much lower than has been observed in other registries 21,[23][24][25][26] .”

    From Incidence and Etiology of Drug-Induced Liver Injury in Mainland China (2019) · cites this paper as [25]

  • AT-DILI is the most common cause of DILI and a common cause of ALF and acute-on-chronic liver failure (ACLF) in Asian countries.

    “Therefore, AT-DILI is the most common cause of DILI and a common cause of ALF and acute-on-chronic liver failure (ACLF) in Asian countries [138,139].”

    From Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update (2024) · cites this paper as [138]

  • Indicators of impaired liver function such as TBil, INR, and albumin are more severe in patients with AT-DILI than in those with DILI caused by other drugs.

    “Studies suggest that indicators of impaired liver function such as TBil, INR, and albumin are more severe in patients with AT-DILI than in those with DILI caused by other drugs [138]; however, additional studies are needed for validation.”

    From Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update (2024) · cites this paper as [138]

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Metadata

Authors
Devarbhavi, H., Dierkhising, R., Kremers, W. K., Sandeep, M. S., Karanth, D., & Adarsh, C. K.
Venue
American Journal of Gastroenterology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2010-11
Volume
105
Issue
11
Pages
2396-2404
ISSN
0002-9270
DOI
10.1038/ajg.2010.287
Cited by
195
References
1
Language
en
Licence
www.springer.com/tdm (unspecified)

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