The Long-term Follow-up of 140 Patients With Drug-induced Liver Injury (DILI): Emphasis on Chronic Risk Factors and Phenotypes

Abstract

Chronic drug-induced liver injury is a concern for both clinicians and patients. We aimed to determine the association between the prognosis with the clinical, serological and histological features of drug-induced liver injury (DILI), and to find the relative risk factors of chronic DILI. Chronic DILI was defined as ongoing abnormal liver function tests (LFTs) of hepatocellular pattern of more than 6 months in duration or mixed/ cholestatic pattern of more than 12 months after cessation of the insulting drugs(s). All the patients needed follow up at least 1 year. One hundred and forty cases were reviewed retrospectively, in which 104 (74.3%) patients could recover quickly, while chronicity developed in 31 (22.1%) patients. The most common types of insulting drugs to chronic DILI were herbs (67.7%). We found that the time intervals of ALT or TBIL decreasing from its peak to half its level (T0.5ALT, T0.5TBIL) were significantly longer in chronic DILI (8.0 (6.8-17.3) and 27.0 (10.0-35.0)) than in the recovered group (6.0 (4.0-8.0) and 8.0 (6.0-12.0)) (P = .003 and P = .000). More importantly, multiple logistic regression analyses revealed that T0.5TBIL was a risk factor independently associated with chronic DILI (OR: 1.253; 95% CI: 1.079-1.456; P = .003). In the histological respect, there had statistically significance in canalicular cholestasis and interface hepatitis between recover group and chronic one (P = .013 and P = .012). We classified chronic DILI into six phenotypes based on its follow-up information, including slowly-decreasing (n = 5), recurrent (n = 10), protracted (n = 10), drug-induced autoimmune hepatitis (D-AIH, n = 2), chronic cholestatic (n = 2) and cirrhotic (n = 2) patterns.ConclusionThe incidence of chronic DILI in this cohort study is around 20%. T0.5TBIL is an independent risk factor of chronicity. The pathological features, such as canalicular cholestasis and interface hepatitis, can help to predict chronicity. According to the changing of LFTs, we can summarize chronic DILI into six phenotypes. Chronic drug-induced liver injury is a concern for both clinicians and patients. We aimed to determine the association between the prognosis with the clinical, serological and histological features of drug-induced liver injury (DILI), and to find the relative risk factors of chronic DILI. Chronic DILI was defined as ongoing abnormal liver function tests (LFTs) of hepatocellular pattern of more than 6 months in duration or mixed/ cholestatic pattern of more than 12 months after cessation of the insulting drugs(s). All the patients needed follow up at least 1 year. One hundred and forty cases were reviewed retrospectively, in which 104 (74.3%) patients could recover quickly, while chronicity developed in 31 (22.1%) patients. The most common types of insulting drugs to chronic DILI were herbs (67.7%). We found that the time intervals of ALT or TBIL decreasing from its peak to half its level (T0.5ALT, T0.5TBIL) were significantly longer in chronic DILI (8.0 (6.8-17.3) and 27.0 (10.0-35.0)) than in the recovered group (6.0 (4.0-8.0) and 8.0 (6.0-12.0)) (P = .003 and P = .000). More importantly, multiple logistic regression analyses revealed that T0.5TBIL was a risk factor independently associated with chronic DILI (OR: 1.253; 95% CI: 1.079-1.456; P = .003). In the histological respect, there had statistically significance in canalicular cholestasis and interface hepatitis between recover group and chronic one (P = .013 and P = .012). We classified chronic DILI into six phenotypes based on its follow-up information, including slowly-decreasing (n = 5), recurrent (n = 10), protracted (n = 10), drug-induced autoimmune hepatitis (D-AIH, n = 2), chronic cholestatic (n = 2) and cirrhotic (n = 2) patterns. ConclusionThe incidence of chronic DILI in this cohort study is around 20%. T0.5TBIL is an independent risk factor of chronicity. The pathological features, such as canalicular cholestasis and interface hepatitis, can help to predict chronicity. According to the changing of LFTs, we can summarize chronic DILI into six phenotypes. The incidence of chronic DILI in this cohort study is around 20%. T0.5TBIL is an independent risk factor of chronicity. The pathological features, such as canalicular cholestasis and interface hepatitis, can help to predict chronicity. According to the changing of LFTs, we can summarize chronic DILI into six phenotypes.