Clinical Characteristics,Risk Factors And Prognosis Of 314 Cases Of Drug-induced Liver Injury

ObjectiveTo evaluate the clinical features, risk factors and prognosis of drug-induced liver injury. MethodsComplete clinical dates of 314 DILI patients from January 2012 to December 2015 in the Second Hospital of Shanxi Medical University were analyzed retrospectively. We analyzed the types of medication which led to liver injury, clinical symptoms, laboratory findings, risk factors and prognosis. Results(1) Clinical symptoms are mainly anorexia, fatigue, jaundice, fever etc. Hepatocellular type of DILI was the most common clinical characteristics. The top three common implicated drugs were agent for neoplasm, antibiotics and Chinese herbal medicine. In the agent for neoplasm, cytarabine 、 arsenic trioxide and cyclophosphamide could be the top three. In the antimi crobials, meropenem、voriconazole and fluconazol could be the top three. Nervous system agent and psychotropic drugs to olanzapine pathogenic role of the most significant.Combination therapy plays a very important role. Combination therapy is mostly used in the agent for neoplasm and antimi crobials.(2) Patients who were fatty、hypoproteinemia、increased of total bilirubin are more easy to develop into cholestatic/mixed type of DILI(P=0.0000).There is no significant difference in sex、with or without underlying liver disease、diabetes mellitus、blood diseases or AST levels. Older people 、 with underlying liver diseases and cholestatic/mixed type usually caused severe damage(P<0.05). The sex and hypoproteinemia have non-business with the severity. Albumin≤28g/L(P=0.0008)、AST≥2ULN(P=0.0075) are the risk factors of prognsis.(3)In all cases,only 64 patients appear imaging abnormal, indicating that DILI mainly result in abnormal laboratory tests, such as liver enzymes, bilirubin,.Only a small part of them could appera imaging change, this situation usuallytook part in the later period of the disease,or associated with other liver diseases.(4) Most DILI have better prognosis. Sex, jaundice and clinical classification had no effect(P> 0.05) on prognosis.(5) With the blood system diseases, 139 cases are hepatocellular type. Improvement in 93 cases, 46 cases of deterioration, sex, ALT level, total bilirubin, anemia have no effect on prognosis(P values were 0.3,0.15, 0.2, 0.1), the patients that age ≥60 years, AST≥3ULN, ALP≥ 2ULN, GGT≥2ULN, albumin <28g / L, N% ≥50%, E% ≥ 3% always with poor prognosis(P values were 0.008,0.001,0.007,0.04,0.01,0.005,0.003).(6) 255 cases of patients achieved RUCAM score, RUCAM value >8 points: 6 cases; RUCAM values between 6-8: 100 cases; RUCAM values between 3-5 points: 133 cases; RUCAM value in 1-2 minutes between: 16 cases. ConclusionsThrough this study we could found that, Patients who were fatty、hypoproteinemia、increased of total bilirubin are more easy to develop into cholestatic/mixed type of DILI. Albumin≤28g/L、AST≥2ULN are the risk factors of prognsis. With the blood system diseases,the patients that age ≥60 years, AST≥3ULN, ALP≥ 2ULN, GGT ≥ 2ULN, albumin <28g / L, N% ≥ 50%, E% ≥ 3% always with poor prognosis.