EVALUATION OF DRUG-INDUCED LIVER INJURY BASED ON EHR AT THREE UNIVERSITY HOSPITAL IN KOREA

Abstract

Introduction Drug-induced liver injury (DILI) has been increasing. However, there are few algorithms to accurately find it through EHR (Electronic Healthcare Record), and it is difficult to investigate the exact incidence and characteristics of DILI. We aimed to identify and evaluate DILI with an appropriate screening protocol. Methods Between June 2015 to May 2016, data were collected from 3 university referral hospital, Seoul, Korea. Among patients with ALT ≤120 IU/L and total bilirubin less than 2.4 mg/dL in the blood test within 48 hours of admission and no other illness related to liver disease at discharge, we retrospectively reviewed the EHR to evaluate the incidence of DILI, and estimate the causative drugs. Results Approximately one-third of the screening patients were identified as DILI. It was more common in male and the 60s, and most were hepatocellular type liver injury. The common causes were piperacillin-tazobactam, methotrexate and acetaminophen. Overall, antibiotics were the most common, followed by chemotherapy agent. Patients excluded from DILI were often associated with ischemic liver injury, postoperative status as well as congestive hepatopathy due to heart failure. Conclusions Antibiotics are the most common culprit drugs for DILI. Modified criteria for detection of DILI should be developed to evaluate DILI more accurately based on EHR in the hospitals.