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Original Article | Open Access

Risk factors related to significant hepatic inflammation in patients with acute drug-induced liver injury

Yu-Ting Xionga,b,1, Jian-Fei Wangc,1, Le Lid,1, Zhi-Fang Baib,1, Yan Liud, Ang Huange, Ke-Xin Wanga,b, Yiming Fub, Wucai Yangb, Chang Guob, Mengwen Hef, Wen-Chang Wangg, Chun-Yan Wangb( ), Dong Jia,b,f,g( )
The PLA 307 Clinical College of Anhui Medical University, The Fifth Clinical Medical College of Anhui Medical University, Hefei 230032, China
Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Emergency Department, the Seventh Medical Center of PLA General Hospital, Beijing 100007, China
Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing 100039, China
Peking University 302 Clinical Medical School, Beijing 100039, China
Chinese PLA Medical School, Beijing 100853, China

1 Yu-Ting Xiong, Jian-Fei Wang, Le Li, and Zhi-Fang Bai contributed equally to this paper.

Show Author Information

Graphical Abstract

(A) Study process and follow-up results. (B) The main results: risk factors for pathological hepatic significant inflammation. AST, aspartate aminotransferase; BMI, body mass index; DILI, drug-induced liver injury; PTA, prothrombin activity; RUCAM, Roussel Uclaf Causality Assessment Method; TBIL, total bilirubin.

Abstract

Background and aims

Currently, research on biopsy-proven acute drug-induced liver injury (DILI) remains limited. This study aimed to identify clinical characteristics and risk factors for significant hepatic inflammation in patients with acute DILI.

Methods

An ambispective cohort study was conducted on biopsy-proven acute DILI patients admitted to our hospital from 2012 to 2018. Using the Scheuer scoring system, patients were categorized into G0-2 or G3-4 groups and followed up for 12 months after first admission. Clinical characteristics and outcomes were retrieved from medical records.

Results

The median age of the 157 enrolled patients (65.6% female) was 40.4 (interquartile range (IQR), 31.9–49.1) years. The median latency and length of hospitalization were 30.0 (IQR, 5.0–60.0) and 18.0 (IQR, 12.0–26.0) days. The proportions of patients in the G0-2 and G3-4 groups were 54.8% and 45.2%, respectively. Logistic regression analysis revealed that females (odds ratio (OR): 2.623, 95% confidence interval (CI): 1.169–5.887, p = 0.019), higher body mass index (OR: 1.168, 95% CI: 1.029–1.325, p = 0.016), higher total bilirubin (OR: 1.004, 95% CI: 1.000–1.007, p = 0.047), and lower prothrombin activity (OR: 0.976, 95% CI: 0,957–0.995, p = 0.013) were associated with significant hepatic inflammation. The predominance of the hepatocellular injury pattern (60.5%) at admission transformed into a predominance of the cholestatic pattern (60.5%) at discharge. During follow-up, 23 patients (14.6%) developed chronic DILI, with nine patients (5.7%) progressing to cirrhosis. Moreover, 15 female patients (9.6%) developed autoimmunity (3cases in the G0-2 group vs 12 cases in the G3-4 group, p < 0.05).

Conclusion

Acute DILI patients with high-risk factors were more likely to develop significant hepatic inflammation, and females with significant inflammation were at a higher risk of developing autoimmunity during follow-up.

Keywords

AutoimmunityLiver biopsyHepatic inflammationFemaleAcute drug-induced liver injuryChronicity

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iLIVER
Volume 3 Issue 2,
June 2024
Article number: 100095
DOI: 10.1016/j.iliver.2024.100095
Cite this article:
Xiong Y-T, Wang J-F, Li L, et al. Risk factors related to significant hepatic inflammation in patients with acute drug-induced liver injury. iLIVER, 2024, 3(2): 100095. https://doi.org/10.1016/j.iliver.2024.100095

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Received: 26 December 2023
Revised: 02 April 2024
Accepted: 21 April 2024
Published: 06 May 2024
© 2024 The Authors. Tsinghua University Press.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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