Clinicopathological features and prognosis analysis of non-alcoholic fatty liver disease complicated with drug-induced liver injury

Abstract

Abstract: Objective To analyze the clinicopathological features and prognosis of non-alcoholic fatty liver disease (NAFLD) complicated with drug-induced liver injury (DILI). Methods A total of 102 patients with DILI confirmed by liver biopsy, who were hospitalized in Pengshui Miao and Tujia Autonomous County People′s Hospital, Pengshui Miao and Tujia Autonomous County Hospital of Chinese Medicine and Chongqing Municipal of Traditional Chinese Medicine. from January 2020 to December 2024, were enrolled. According to the presence or absence of NAFLD, they were divided into an observation group (n=38) and a control group (n=64). The clinical characteristics, liver pathological features, and clinical outcomes were compared between the two groups. Results The BMI in the observation group was significantly higher than that in the control group (27.8±2.5 vs. 22.9±1.8 kg/m², P<0.05), and the incidence rates of type 2 diabetes (31.6% vs. 7.8%) and hyperlipidemia (47.4% vs. 14.1%) were also markedly increased (both P<0.05). The peak ALP level in the observation group was significantly lower than that in the control group [185 (145, 250) vs. 245 (180, 355) U/L, P<0.05]. Regarding liver histology, no significant differences were observed in portal inflammation (78.9% vs. 85.9%), eosinophil infiltration (26.3% vs. 39.1%), or bile duct injury (10.5% vs. 14.1%) between the two groups (P>0.05). However, the proportion of patients with hepatocellular ballooning was significantly higher in the observation group (65.8% vs. 12.5%, P<0.05), and the rate of advanced liver fibrosis (≥S3) was also markedly increased (21.1% vs. 3.1%, P<0.05). Follow-up outcomes revealed that the 3-month biochemical resolution rate was significantly lower in the observation group (65.8% vs. 85.9%, P<0.05), and the time to biochemical resolution was significantly prolonged [75 (45, 120) vs. 48 (30, 75) days, P<0.05]. The incidence of disease progression within 6 months was significantly higher in the observation group (18.4% vs. 3.1%, P<0.05), including 5 cases progressing to cirrhosis and 2 cases developing hepatic decompensation, whereas only one case each occurred in the control group. Conclusion NAFLD is a potential susceptibility factor for DILI and can significantly influence the disease severity, histological pattern, and clinical outcomes of DILI.

Key words: Drug-induced liver injury, Non-alcoholic fatty liver disease, Biochemical resolution

Mao Fei, Tao Yue, Dong Lei, Ou Jiang. Clinicopathological features and prognosis analysis of non-alcoholic fatty liver disease complicated with drug-induced liver injury[J]. Chinese Hepatolgy, 2026, 31(8): 1156-1159.

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