Clinical and pathological features of drug-induced liver injury due to non-steroidal anti-inflammatory drugs

Abstract

Objective To explore the clinical and pathological features of drug-induced liver injury (DILI) due to non-steroidal anti-inflammatory drugs (NSAIDs). Methods The medical records of patients with discharged diagnosis of drug-induced liver injury, which were searched from the Hospital Information System of Shijiazhuang Fifth Hospital from January 1, 2013 to December 31, 2016, were collected and analyzed retrospectively. The patients with DILI due to NSAIDs were enrolled into the NSAIDs group and the patients with DILI due to other drugs were enrolled into the control group. The general conditions, results of laboratory tests, and detection results of liver histopathology in patients in the 2 groups were recorded. The score of Roussel Uclaf Causality Assessment Method (RUCAM), clinical type and classification, pathological type and classification, and clinical outcome evaluation of the DILI patients in the 2 groups were performed according to the relevant standards by the members of research team. Results A total of 385 patients were enrolled into the study, including 63 cases in the NSAIDs group and 322 cases in the control group. The differences of sexual distinction, age, and clinical manifestation were not statistically significant (P>0.05 for all). The results of types and severity classification of DILI based on R value showed that the differences of the proportion of patients with different DILI types and classifications between the 2 groups were not statistically significant (P>0.05 for all). Forty-one and 142 patients underwent liver biopsy in the NSNIDs group and the control group, respectively. The results of liver biopsy showed that the proportion of patients with type of vascular injury in the NSAIDs group was significantly higher than that in the control group [4.9% (2/41) vs. 0 (0/142), χ2=7.003, P=0.049]; the incidences of inflammation in the portal area and proliferation of bile duct in the NSAIDs group were statistically lower than those in the control group [(63.4%(26/41) vs. 93.7%(133/142), χ2=25.544, P 0.05]. There were no death in both groups. Conclusions The clinical manifestations and clinical outcomes of patients with DILI due to NSAIDs were similar to those due to other drugs. The pathological characteristics of liver were that the incidence of inflammation and proliferation of bile duct in the portal area was lower than that of other drugs, and the incidence of hepatocyte steatosis was higher than that of other drugs. Vascular injury was also observed. Key words: Chemical and drug induced liver injury; Anti-inflammatory agents, non-steroidal; Pathology, clinical