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Abstract
Background: We investigated the prevalence, demographic and clinical features, and risk factors associated with drug-induced liver injury (DILI) during the treatment of brucellosis inpatients in a retrospective study. Methods: We collected the clinical data of 782 brucellosis inpatients admitted at the Shawan County People’s Hospital, Xinjiang, from 2015–2019. All cases were re-evaluated using the international consensus of DILI criteria and RUCAM rating scale. 71 patients were confirmed as DILI cases and compared with 523 other patients with normal liver function. Results: It was indicated that DILI occurred with a prevalence of about 9.08% among brucellosis inpatients receiving drug therapy. Hepatocellular injury was the most common type of DILI (61.97%, 95% confidence interval [CI] 50.34–72.37), followed by mixed (23.94%, 95% CI 15.52–35.04) and cholestatic types (14.08%, 95% CI 7.83–24.02). In addition, 13.64% of the hepatocellular DILI cases fulfilled Hy’s law criteria and only two cases (2.82%) progressed to severe DILI. Most patients adopted the combination of rifampicin, antipyretic analgesics, anti-infective agents, and traditional Chinese medicine for the treatment of brucellosis, with all the 71 patients taking rifampicin as the drug of choice. Multivariable logistic regression analyses indicated that obesity, regular alcohol intake, and decreased serum albumin were the independent risk factors of DILI in patients with brucellosis after adjusting for gender, age, and ethnicity. Conclusion: DILI occurred in a minority of inpatients diagnosed with brucellosis receiving rifampicin-based therapeutic regimen. In addition, obesity, alcohol abuse, and decreased serum albumin were valuable predictors of the risk of DILI in patients with brucellosis.
Highlights
Drug-induced liver injury refers to liver damage induced by various prescription or non-prescription chemical drugs, biological agents, traditional Chinese medicines, dietary supplements, and their metabolites, which is one of the most frequent and serious adverse drug reactions as well as the leading challenge in clinical treatment (Navarro and Senior, 2006).Brucellosis, one of the most common zoonotic infectious diseases in the world, is a transmissible infectious disease caused by the invasion of Brucella burgdorferi
The time of onset after starting the drug and the time of recovery after stopping the drug was recorded; 4) Symptoms and signs including time of occurrence, time of disappearance, and symptoms during hospitalization were recorded in detail; 5) Serum biochemical indexes such as ALT, AST, alkaline phosphatase (ALP), total bilirubin (TBil), DBil, prothrombin time (PT), and international normalized ratio (INR) before and during the drug-induced liver injury (DILI) event; 6) Etiology analysis of other causes which may have resulted in liver damage (including hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis E virus (HEV), herpes virus, Wilson’s disease, and autoimmune hepatitis); and 7) Severity of liver damage during the DILI event
DILI among patients with brucellosis during the 5 years observation period was 9.08% (Table 1)
Summary
Drug-induced liver injury refers to liver damage induced by various prescription or non-prescription chemical drugs, biological agents, traditional Chinese medicines, dietary supplements, and their metabolites, which is one of the most frequent and serious adverse drug reactions as well as the leading challenge in clinical treatment (Navarro and Senior, 2006).Brucellosis, one of the most common zoonotic infectious diseases in the world, is a transmissible infectious disease caused by the invasion of Brucella burgdorferi. The annual incidence can reach up to 1/1000 in brucellosis endemic areas such as Latin America and the Middle East (Buzgan et al, 2010). In China, the rapid development of animal husbandry and tourism in the past few years has raised the risk of human infection, with 44,036 cases of human infection reported in 2019 alone, and an annual incidence rate of 3.25 infections per 100,000 people. From 2015–2019, the incidence of brucellosis in China fluctuated between 2.73–4.18 per 100,000 people, and was significantly higher in pastoral areas such as Xinjiang, Inner Mongolia, Gansu, and Qinghai (Jiang et al, 2020). Demographic and clinical features, and risk factors associated with drug-induced liver injury (DILI) during the treatment of brucellosis inpatients in a retrospective study
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