The Analysis Of Clinical Features In 485 Patients With Drug Induced Liver Injury

Objective:To analyze the clinical features and major drugs of drug induced liver injury(DILI),and analyze the risk factors and prognosis of drug induced liver failure.Methods:Clinical data including medical history,age,gender,basic diseases,biochemistry and prognosis of 485 patients with DILI who were hospitalized in Shengjing Hospital of China Medical University from January 2013 to December 2017were collected.Clinical characteristics of DILI and risk factors for liver failure were analyzed retrospectively and multifariously.The data were expressed as percentages and quartile spacing.The data with clinical characteristics of DILI in line with normal distribution were tested by t test,and the data with non-normal distribution were tested by nonparametric test(Mann-whitney U test).Clinical features,prognostic features and other enumeration data of DILI were tested by?~2 test.Logistic regression was used for multivariate analysis of hepatic failure.Results:Among the 485 patients with DILI,173(35.7%)were male and 312(64.3%)were female.The majority were aged 46-60 years old(179/485,36.91%).These patients with DILI ranged from 1 year old to 85 years old.Among the 485 patients with DILI,328cases(67.63%)were caused by traditional Chinese medicine,154 cases(31.75%)were caused by western medicine,and 3 cases(0.62%)were unknown.The first four cases of485 patients with DILI complicated with basic diseases were infectious diseases(76/368,20.65%),bone and joint diseases(62/368,16.85%),skin diseases and cardiovascular and cerebrovascular diseases(55/368,14.95%).The top four western drugs causing DILI are anti-tuberculosis drugs,antipyretic and analgesic drugs(30/154,19.48%),antibiotics(21/154,13.63%)and anti-tumor drugs(15/154,9.74%).Hepatocyte injury type was the most common clinical type(295/485,60.82%).There was significant difference between age,gender and advanced age in liver injury caused by traditional Chinese medicine and western medicine(P<0.05),and DILI was more likely to occur in elderly women using traditional Chinese medicine than western medicine.Among 485 patients with DILI,419 patients(86.39%)had a improved condition.There was no significant difference in the prognosis of patients with DILI caused by different drugs(?~2=0.685,P=0.398>0.05),and there was significant difference in the prognosis of patients with DILI caused by different clinical types(?~2=6.46,P=0.039<0.05),cholestasis has the worst prognosis.Among the 485 patients with DILI,66(13.61%)patients developed liver failure,46(69.70%)patients was the type of hepatocyte injury.Among the 19 children with DILI,36.84%(7/19)children develped the liver failure,4(57.14%)children with liver failure was due of APAP.The main western drugs resulted in liver failure were:anti-tuberculosis drugs,antipyretic analgesics.The traditional Chinese medicine resulted in liver failure were:disappear silver piece,polygonum multiflorum,gynura segetum.Conclusion:Old age,female ang combined wtih basic diseases were the susceptipility factors of DILI.Hepatocyte injury was the most common clinical type,and was easy to develped liver failure.Children were more likely to have drug-induced liver failure.The prognosis of most patients with DILI was good,different clinical types of liver injury have different prognosis,and the prognosis of cholestasis type was most poor.Western medicine,high total bilirubin ang INR were risk factors for liver failure.