Clinical characteristics of patients with recurrent chronic drug-induced liver injury:an analytical study

Abstract

Abstract: Objective To analyze the clinical characteristics of patients with recurrent chronic drug-induced liver injury. Methods A retrospective analysis was conducted on the clinical data of 265 patients with chronic drug-induced liver injury who were admitted to our hospital between March 2020 and March 2023. After a one-year follow-up, patients were categorized into two groups : a recurrent group(n=33) and a non-recurrent group (n=232), based on the presentce of recurrence. The study compared general informaion, laboratory examination indicators, and liver histological characteristics between the two groups to identify the clinical features associated with the recurrence of chronic drug-induced liver injury. Multivariate logistic regression was employed to analyze high-risk factors for recurrence. Results The mean ages of the recurrent and non-recurrent groups were 44.2±7.9 years and 40.8±7.5 years, respectively, with the difference being statistically significant (P<0.05). The levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBil), γ -glutamyltranspeptidase(GGT), and prothrombin time(PT) in the recurrence group were 89.4±13.2 U/L, 87.2±12.5 U/L, 47.3±6.3 μmol/L, 105.4±15.4 U/L and 14.2±2.7 s. respectively. These are significantly higher compared to the non-recurrent group, which had ALT, AST, TBil, GGT. And PT values of 37.5±7.1 U/L, 32.3±7.0 U/L, 15.2±2.0 μmol/L, 45.3±8.5 U/L and 12.6±2.3 s, respectively(P<0.05). Additionally, the recurrent group exhibited more severe liver inflammation and fibrosis, with rates of 75.8% and 36.3%, compared to 9.9% and 23.7% in the non-recurrent groups, respectively (P<0.05). Multivariate logistic regression analysis identified age, AST, TBil, GGT, PT, cholinesterase, degree of inflammation, and degree of fibrosis as significant risk factors for the recurrence of chronic drug-induced liver injury (OR=5.068, 4.909, 4.993, 4.604, 4.688, 4.531, 4.627, 5.023, P<0.05). Conclusion When chronic drug-induced liver injury recurs, patients typically present with advanced age, abnormal laboratory findings, and more severe liver inflammation, and fibrosis. This high-risk group warrants careful clinical attention.

Key words: Chronic drug-induced liver injury, Recurrence of the condition, Clinical features

LI Ming-jing, LI Bei-bei, MENG Qing-yu, ZHONG Xin-mei. Clinical characteristics of patients with recurrent chronic drug-induced liver injury:an analytical study[J]. Chinese Hepatolgy, 2024, 29(9): 1128-1131.

References

[1] 王巧玲, 梁庆生, 黄昂, 等. 255例肝穿刺证实的慢性药物性肝损伤患者预后的影响因素分析[J]. 临床肝胆病杂志,2022,38(6):1334-1340.
[2] Sun N, Yang T, Tang Y, et al. Lycopene alleviates chronic stress-induced liver injury by inhibiting oxidative stress-mediated endoplasmic reticulum stress pathway apoptosis in rats[J]. J Agric Food Chem,2022,70(45):14414-14426.
[3] 卢俊竹, 陈广成, 陈慧, 等. 药物性肝损伤与慢性肝病急性加重相关性的临床研究——附301例分析[J]. 新医学,2020,51(2):138-142.
[4] Kulkarni AV, Ravikumar ST, Tevethia H, et al. Safety and efficacy of terlipressin in acute-on-chronic liver failure with hepatorenal syndrome-acute kidney injury (HRS-AKI): a prospective cohort study[J]. Sci Rep,2022,12(1):5503.
[5] Hu C, Zhao L, Wu Z, et al. Transplantation of mesenchymal stem cells and their derivatives effectively promotes liver regeneration to attenuate acetaminophen-induced liver injury.[J] Stem Cell Res Ther,2020,11(1):88.
[6] Santos G, Figueira ERR, D'Albuquerque LAC, et al. Evaluation of drug-induced liver injury as etiology for acute liver failure in Brazil. Ann Hepatol,2021,23:100310.
[7] 中华医学会, 中华医学会杂志社, 中华医学会消化病学分会, 等. 药物性肝损伤基层诊疗指南(2019年)[J]. 中华全科医师杂志,2020,19(10):868-875.
[8] Fontana R J, Hayashi PH, Barnhart H, et al. Persistent liver biochemistry abnormalities are more common in older patients and those with cholestatic drug induced liver injury[J]. Am J Gastroenterol,2015,110(10):1450-1459.
[9] Medina-Caliz I, R obles-Diaz M, Garcia-Mu?oz B, et al. Definition and risk factors for chronicity following acute idiosyncratic drug-induced liver injury[J]. J Hepatol,2016,65(3):532-542.
[10] Wang JB, Huang A, Wang Y, et al. Corticosteroid plus glycyrrhizin therapy for chronic drug- or herb-induced liver injury achieves biochemical and histological improvements: a randomised open-label trial[J]. Aliment Pharmacol Ther,2022,55(10):1297-1310.
[11] Zhang Z, Yao T, Zhao N, et al. Disruption of peroxisome proliferator-activated receptor α in hepatocytes protects against acetaminophen-induced liver injury by activating the IL-6/STAT3 pathway[J]. Int J Biol Sci,2022,18(6):2317-2328.
[12] Fang Z, Xu Y, Liu G, et al. Narirutin activates TFEB (transcription factor EB) to protect against Acetaminophen-induced liver injury by targeting PPP3/calcineurin[J]. Autophagy,2023,19(8):2240-2256.
[13] Ould-Nana I, Cillis M, Gizzi M, et al. Rhabdomyolysis and acute kidney injury induced by the association of rosuvastatin and abiraterone: A case report and review of the literature[J]. J Oncol Pharm Pract,2021,27(1):216-219.
[14] 王丽苹, 何婷婷, 崔延飞, 等. 解放军总医院第五医学中心2009年-2019年老年药物性肝损伤患者的临床特征及变化趋势[J]. 临床肝胆病杂志,2020,36(10):2248-2252.
[15] Chen J, Wu H, Tang X, et al. 4-Phenylbutyrate protects against rifampin-induced liver injury via regulating MRP2 ubiquitination through inhibiting endoplasmic reticulum stress[J]. Bioengineered,2022,13(2):2866-2877.
[16] Treem WR, Palmer M, Lonjon-Domanec I, et al. Consensus Guidelines: Best Practices for Detection, Assessment and Management of Suspected Acute Drug-Induced Liver Injury During Clinical Trials in Adults with Chronic Viral Hepatitis and Adults with Cirrhosis Secondary to Hepatitis B, C and Nonalcoholic Steatohepatitis[J]. Drug Saf,2021,44(2):133-165.
[17] Anand AC, Nandi B, Acharya SK, et al. Indian National Association for the Study of the Liver Consensus Statement on Acute Liver Failure (Part 1): Epidemiology, Pathogenesis, Presentation and Prognosis[J]. J Clin Exp Hepatol,2020,10(4):339-376.
[18] Kataoka H, Tomita T, Nakanowatari M, et al. Gradual increase of avacopan dose with concomitant ursodeoxycholic acid use may help avoid the risk of C5a receptor inhibitor-induced liver injury in antineutrophil cytoplasmic antibody-associated vasculitis[J]. Mod Rheumatol Case Rep,2023,7(2):444-447.
[19] 段昕妤, 吴凯, 朱超慧, 等. 还原型谷胱甘肽联合多烯磷脂酰胆碱对急性药物性肝损伤患者肝功能、肝纤维化指标及血清炎性因子的影响[J]. 现代生物医学进展,2021,21(14):2679-2682.
[20] Ebrahim HA, Kamar SS, Haidara MA, et al. Association of resveratrol with the suppression of TNF-α/NF-kB/iNOS/HIF-1α axis-mediated fibrosis and systemic hypertension in thioacetamide-induced liver injury[J]. Naunyn Schmiedebergs Arch Pharmacol,2022,395(9):1087-1095.