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Cited by 85Liver Disease and TransplantationDrug-Induced Hepatotoxicity and ProtectionLiver Disease Diagnosis and Treatment

The DOI matches its Crossref record; 1 of the 1 references it cites were found in a registry or an index.

Drug-Induced Acute-on-Chronic Liver Failure in Asian Patients

Devarbhavi, Harshad, Choudhury, Ashok Kumar, Sharma, Manoj Kumar, Maiwall, Rakhi, Al Mahtab, Mamun, Rahman, Salimur, Chawla, Yogesh K., Dhiman, Radha K., Duseja, Ajay, Taneja, Sunil, Ning, Qin, Jia, Ji Dong, Duan, Zhongping, Yu, Chen, Eapen, Chundamannil E., Goel, Ashish, Tan, Soek Siam, Hamid, Saeed Sadiq, Butt, Amna Subhan, Jafri, Wasim, Kim, Dong Joon, Hu, Jinhua, Sood, Ajit, Midha, Vandana, Shukla, Akash, Ghazinian, Hasmik, Sahu, Manoj Kumar, Treeprasertsuk, Sombat, Lee, Guan Huei, Lim, Seng Gee, Lesmana, L.A., Lesmana, Cosmas Rinaldi, Shah, Samir, Kalal, Chetan, Abbas, Zaigham, Sollano, Jose D., Prasad, V.G. Mohan, Payawal, Diana Alacantra, Dokmeci, A. Kadir, Rao, P. Nagaraja, Shrestha, Ananta, Lau, George K., Yuen, Man Fung, Saraswat, Vivek A., Shiha, Gamal, Yokosuka, Osamu, Kedarisetty, Chandan Kumar, Jain, Priyanka, Bhatia, Puja, Sarin, Shiv K., for the APASL ACLF working party·2019·American Journal of Gastroenterology
DOI 10.14309/ajg.0000000000000201
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Abstract

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.

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  • In some cohorts, DILI in patients with underlying liver disease has been associated with mortality rates as high as 16%, compared to ~5% in patients without pre-existing liver disease.

    “In some cohorts, DILI in patients with underlying liver disease has been associated with mortality rates as high as 16%, compared to ~5% in patients without pre-existing liver disease.8,27,28”

    From Ashwagandha-induced liver injury—A case series from India and literature review (2023) · cites this paper as [27]

  • 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 [139]

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Research works printed but not linked: 34

  1. Sarin, 2009, Acute-on-chronic liver failure: Consensus recommendations of the asian pacific association for the study of the liver (APASL), Hepatol Int, 3, 269, 10.1007/s12072-008-9106-x · DOI
  2. Sarin, 2016, Acute-on-chronic liver failure: Terminology, mechanisms and management, Nat Rev Gastroenterol Hepatol, 13, 131, 10.1038/nrgastro.2015.219 · DOI
  3. Arroyo, 2016, Acute-on-chronic liver failure: Definition, diagnosis, and clinical characteristics, Semin Liver Dis, 36, 109, 10.1055/s-0036-1583202 · DOI
  4. Katoonizadeh, 2010, Early features of acute-on-chronic alcoholic liver failure: A prospective cohort study, Gut, 59, 1561, 10.1136/gut.2009.189639 · DOI
  5. Hamid, 2002, Hepatitis E virus superinfection in patients with chronic liver disease, Hepatology, 36, 474, 10.1053/jhep.2002.34856 · DOI
  6. Radha Krishna, 2009, Clinical features and predictors of outcome in acute hepatitis A and hepatitis E virus hepatitis on cirrhosis, Liver Int, 29, 392, 10.1111/j.1478-3231.2008.01887.x · DOI
  7. Moreau, 2013, Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis, Gastroenterology, 144, 1426, 10.1053/j.gastro.2013.02.042 · DOI
  8. Lin, 2014, Cirrhosis as a risk factor for tuberculosis infection—a nationwide longitudinal study in Taiwan, Am J Epidemiol, 180, 103, 10.1093/aje/kwu095 · DOI
  9. Thulstrup, 2000, Incidence and prognosis of tuberculosis in patients with cirrhosis of the liver. A Danish nationwide population based study, Epidemiol Infect, 124, 221, 10.1017/S0950268899003593 · DOI
  10. Lewis, 2013, Review article: Prescribing medications in patients with cirrhosis—a practical guide, Aliment Pharmacol Ther, 37, 1132, 10.1111/apt.12324 · DOI
  11. Watkins, 2008, Using controlled clinical trials to learn more about acute drug-induced liver injury, Hepatology, 48, 1680, 10.1002/hep.22633 · DOI
  12. Lo Re, 2016, Oral azole antifungal medications and risk of acute liver injury, overall and by chronic liver disease status, Am J Med, 129, 283, 10.1016/j.amjmed.2015.10.029 · DOI
  13. Verbeeck, 2008, Pharmacokinetics and dosage adjustment in patients with hepatic dysfunction, Eur J Clin Pharmacol, 64, 1147, 10.1007/s00228-008-0553-z · DOI
  14. Tarantino, 2007, A prospective study of acute drug-induced liver injury in patients suffering from non-alcoholic fatty liver disease, Hepatol Res, 37, 410, 10.1111/j.1872-034X.2007.00072.x · DOI · Paper page
  15. Chalasani, 2015, Features and outcomes of 899 patients with drug-induced liver injury: The DILIN prospective study, Gastroenterology, 148, 1340, 10.1053/j.gastro.2015.03.006 · DOI · Paper page
  16. Pais, 2014, The impact of obesity and metabolic syndrome on chronic hepatitis B and drug-induced liver disease, Clin Liver Dis, 18, 165, 10.1016/j.cld.2013.09.015 · DOI
  17. Chang, 2012, UGT1A1 polymorphisms associated with risk of induced liver disorders by anti-tuberculosis medications, Int J Tuberc Lung Dis, 16, 376, 10.5588/ijtld.11.0404 · DOI
  18. Hoffmann, 2007, Hepatotoxicity in an african antiretroviral therapy cohort: The effect of tuberculosis and hepatitis B, AIDS, 21, 1301, 10.1097/QAD.0b013e32814e6b08 · DOI
  19. Jalan, 2014, Toward an improved definition of acute-on-chronic liver failure, Gastroenterology, 147, 4, 10.1053/j.gastro.2014.05.005 · DOI
  20. Shi, 2015, Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults, Hepatology, 62, 232, 10.1002/hep.27795 · DOI
  21. Sarin, 2014, Acute-on-chronic liver failure: Consensus recommendations of the asian pacific association for the study of the liver (APASL) 2014, Hepatol Int, 8, 453, 10.1007/s12072-014-9580-2 · DOI · Paper page
  22. Chalasani, 2016, Drug-induced liver injury in patients with preexisting chronic liver disease in drug development: How to identify and manage?, Gastroenterology, 151, 1046, 10.1053/j.gastro.2016.10.010 · DOI
  23. Björnsson, 2005, Outcome and prognostic markers in severe drug-induced liver disease, Hepatology, 42, 481, 10.1002/hep.20800 · DOI · Paper page
  24. Devarbhavi, 2010, Single-center experience with drug-induced liver injury from India: Causes, outcome, prognosis, and predictors of mortality, Am J Gastroenterol, 105, 2396, 10.1038/ajg.2010.287 · DOI · Paper page
  25. Saigal, 2001, Safety of an ofloxacin-based antitubercular regimen for the treatment of tuberculosis in patients with underlying chronic liver disease: A preliminary report, J Gastroenterol Hepatol, 16, 1028, 10.1046/j.1440-1746.2001.02570.x · DOI
  26. Devarbhavi, 2013, Outcome and determinants of mortality in 269 patients with combination anti-tuberculosis drug-induced liver injury, J Gastroenterol Hepatol, 28, 161, 10.1111/j.1440-1746.2012.07279.x · DOI · Paper page
  27. Saukkonen, 2006, An official ATS statement: Hepatotoxicity of antituberculosis therapy, Am J Respir Crit Care Med, 174, 935, 10.1164/rccm.200510-1666ST · DOI
  28. Fromenty, 2013, Drug-induced liver injury in obesity, J Hepatol, 58, 824, 10.1016/j.jhep.2012.12.018 · DOI
  29. Chen, 2015, Drug-induced liver injury: Interactions between drug properties and host factors, J Hepatol, 63, 503, 10.1016/j.jhep.2015.04.016 · DOI
  30. Seeff, 2015, Herbal products and the liver: A review of adverse effects and mechanisms, Gastroenterology, 148, 517, 10.1053/j.gastro.2014.12.004 · DOI
  31. Ibáñez, 2002, Prospective surveillance of acute serious liver disease unrelated to infectious, obstructive, or metabolic diseases: Epidemiological and clinical features, and exposure to drugs, J Hepatol, 37, 592, 10.1016/S0168-8278(02)00231-3 · DOI
  32. Lo Re, 2015, Risk of acute liver failure in patients with drug-induced liver injury: Evaluation of Hy's law and a new prognostic model, Clin Gastroenterol Hepatol, 13, 2360, 10.1016/j.cgh.2015.06.020 · DOI
  33. Antoine, 2017, Transformative biomarkers for drug-induced liver injury: Are we there yet?, Biomark Med, 11, 103, 10.2217/bmm-2016-0338 · DOI
  34. Everson, 2012, Quantitative liver function tests improve the prediction of clinical outcomes in chronic hepatitis C: Results from the hepatitis C antiviral Long-term treatment against cirrhosis trial, Hepatology, 55, 1019, 10.1002/hep.24752 · DOI

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Metadata

Authors
Devarbhavi, H., Choudhury, A. K., Sharma, M. K., Maiwall, R., Al Mahtab, M., Rahman, S., Chawla, Y. K., Dhiman, R. K., Duseja, A., Taneja, S., Ning, Q., Jia, J. D., Duan, Z., Yu, C., Eapen, C. E., Goel, A., Tan, S. S., Hamid, S. S., Butt, A. S., Jafri, W., Kim, D. J., Hu, J., Sood, A., Midha, V., Shukla, A., Ghazinian, H., Sahu, M. K., Treeprasertsuk, S., Lee, G. H., Lim, S. G., Lesmana, L. A., Lesmana, C. R., Shah, S., Kalal, C., Abbas, Z., Sollano, J. D., Prasad, V. G. M., Payawal, D. A., Dokmeci, A. K., Rao, P. N., Shrestha, A., Lau, G. K., Yuen, M. F., Saraswat, V. A., Shiha, G., Yokosuka, O., Kedarisetty, C. K., Jain, P., Bhatia, P., Sarin, S. K., & party, F. T. A. A. W.
Affiliations
  • St.John's Medical College Hospital (IN)
  • Institute of Liver and Biliary Sciences (IN)
  • Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh;
  • Bangladesh Medical University (BD)
  • Post Graduate Institute of Medical Education and Research (IN)
  • Tongji Hospital (CN)
  • Capital Medical University (CN)
  • Translational Hepatology Institute Capital Medical University, Beijing You'an Hospital;
  • Christian Medical College, Vellore (IN)
  • Hospital Selayang (MY)
  • Aga Khan University (PK)
  • Hallym University (KR)
  • 302 Military Hospital of China (CN)
  • Department of Gastroenterology, DMC, Ludhiana, India;
  • King Edward Memorial Hospital and Seth G.S. Medical College (IN)
  • Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Armenia;
  • Institute of Medical Sciences and Sum Hospital (IN)
  • Chulalongkorn University (TH)
  • National University of Singapore (SG)
  • Department of Medicine, Medistra Hospital, Jakarta, Indonesia;
  • Global Hospitals (IN)
  • Ziauddin Hospital (PK)
  • VGM Gastro Centre (IN)
  • Cardinal Santos Medical Center (PH)
  • Department of Medicine, Ankara University School of Medicine, Turkey;
  • Asian Institute of Gastroenterology (IN)
  • Department of Hepatology, Foundation Nepal Sitapaila Height, Kathmandu;
  • Humanity & Health (CN)
  • Queen Mary Hospital (CN)
  • Sanjay Gandhi Post Graduate Institute of Medical Sciences (IN)
  • Mansoura University Hospital (EG)
  • Chiba University (JP)
Corresponding author
Sarin, Shiv K.
ORCID
Venue
American Journal of Gastroenterology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-04-22
Volume
114
Issue
6
Pages
929-937
ISSN
  • 0002-9270 (ISSN-L)
  • 1572-0241
DOI
10.14309/ajg.0000000000000201
OpenAlex
W2941411671
Cited by
85
References
1
Citations by year
2026: 10 · 2025: 9 · 2024: 21 · 2023: 11 · 2022: 7 · 2021: 16 · 2020: 8 · 2019: 3
FWCI
4.78
Type
journal article
Language
en
Open access
closed
Locations
  • The American Journal of Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
  • eCommons - AKU (Aga Khan University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
  • Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
Keywords
acute-on-chronic liver failure, drug-induced liver injury, complementary and alternative medicine, antitubercular agents, mortality risk factors, arterial lactate, total bilirubin, hepatic encephalopathy, Asian patients
MeSH terms
Adolescent, Adult, Aged, Asia, Biopsy, Female, Follow-Up Studies, Humans, Liver, Male, Middle Aged, Morbidity, Prognosis, Prospective Studies, Time Factors, Survival Rate, Young Adult, Chemical and Drug Induced Liver Injury, Acute-On-Chronic Liver Failure

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