TY - JOUR
T1 - Clinical characteristics and outcomes of drug-induced liver injury in Taiwan
T2 - With emphasis on the impact of chronic hepatitis B infection
AU - Huang, Yi Shin
AU - Tseng, Shao Yu
AU - Chen, Wen Wen
AU - Chang, Ting Tsung
AU - Peng, Cheng Yuan
AU - Lo, Gin Ho
AU - Hsu, Chao Wei
AU - Hu, Chi Tan
AU - Huang, Yi Hsiang
N1 - Funding Information:
The authors thank all the members of Review Board in TDRF to scrutinize and review the patients with DILI in this study. The study was supported by the grants from Taiwan Food and Drug Administration (TFDA), Department of Health of the Executive Yuan (now the Ministry of Health and Welfare), Taiwan (DOH100-99TFDA-P-092 and DOH101-FDA-41103), and Taipei Veterans General Hospital, Taiwan (V110C-022).
Publisher Copyright:
© 2022 Wolters Kluwer Health. All rights reserved.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Background: Whether hepatitis B virus (HBV) infection can affect the outcomes of drug-induced liver injury (DILI) is controversial. This study aimed to evaluate the characteristics and outcomes of DILI in Taiwan, with an emphasis on the impact of HBV infection. Methods: We prospectively recruited patients with DILI from multiple centers in Taiwan from 2010 to 2018. Results: A total of 1,014 patients were enrolled. The leading culprit drug category was antimicrobials (481, 47.4%), followed by nonsteroidal anti-inflammatory drugs, anticonvulsants, and statins. Among the antimicrobials, antituberculosis agents were most likely to induce liver injury (257, 25.3%), followed by antibacterial, antifungal, and antiviral agents. The liver-related mortality rate was 8.2% (83/1,014). The patients who died had higher rates of hepatocellular-type liver injury, elevated liver biochemical tests, preexisting liver cirrhosis, jaundice, chronic HBV infection, and antituberculosis drug-induced liver injury (ATDILI) than the survivors. A total of 131 patients (12.9%) with DILI were HBV carriers, of whom 23 (17.6%) died of hepatic failure. The rate of HBV-DNA > 2000 IU/mL was higher in the patients who died (47.8% vs. 26.9%, p = 0.047) than in the survivors. After adjusting for possible risk factors, active HBV infection with HBV-DNA > 2000 IU/mL was the most significant risk factor for liver-related mortality (adjusted HR, 4.40, 95% CI, 2.31%-8.38%, p < 0.001). The other independent risk factors for mortality were ATDILI and albumin-bilirubin (ALBI) score (adjusted HR, 1.25 and 4.09, respectively, p < 0.003). Conclusion: Antituberculosis agents were the leading cause of DILI in Taiwanese, and they were associated with poorer outcomes than other drug categories. Active HBV infection, ATDILI and ALBI score were independent risk factors for fatal DILI. Close monitoring of liver tests and timely antiviral therapy should be implemented in HBV carriers during the administration of high-risk drugs, such as antituberculosis agents.
AB - Background: Whether hepatitis B virus (HBV) infection can affect the outcomes of drug-induced liver injury (DILI) is controversial. This study aimed to evaluate the characteristics and outcomes of DILI in Taiwan, with an emphasis on the impact of HBV infection. Methods: We prospectively recruited patients with DILI from multiple centers in Taiwan from 2010 to 2018. Results: A total of 1,014 patients were enrolled. The leading culprit drug category was antimicrobials (481, 47.4%), followed by nonsteroidal anti-inflammatory drugs, anticonvulsants, and statins. Among the antimicrobials, antituberculosis agents were most likely to induce liver injury (257, 25.3%), followed by antibacterial, antifungal, and antiviral agents. The liver-related mortality rate was 8.2% (83/1,014). The patients who died had higher rates of hepatocellular-type liver injury, elevated liver biochemical tests, preexisting liver cirrhosis, jaundice, chronic HBV infection, and antituberculosis drug-induced liver injury (ATDILI) than the survivors. A total of 131 patients (12.9%) with DILI were HBV carriers, of whom 23 (17.6%) died of hepatic failure. The rate of HBV-DNA > 2000 IU/mL was higher in the patients who died (47.8% vs. 26.9%, p = 0.047) than in the survivors. After adjusting for possible risk factors, active HBV infection with HBV-DNA > 2000 IU/mL was the most significant risk factor for liver-related mortality (adjusted HR, 4.40, 95% CI, 2.31%-8.38%, p < 0.001). The other independent risk factors for mortality were ATDILI and albumin-bilirubin (ALBI) score (adjusted HR, 1.25 and 4.09, respectively, p < 0.003). Conclusion: Antituberculosis agents were the leading cause of DILI in Taiwanese, and they were associated with poorer outcomes than other drug categories. Active HBV infection, ATDILI and ALBI score were independent risk factors for fatal DILI. Close monitoring of liver tests and timely antiviral therapy should be implemented in HBV carriers during the administration of high-risk drugs, such as antituberculosis agents.
UR - http://www.scopus.com/inward/record.url?scp=85124226663&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85124226663&partnerID=8YFLogxK
U2 - 10.1097/JCMA.0000000000000648
DO - 10.1097/JCMA.0000000000000648
M3 - Article
C2 - 34698694
AN - SCOPUS:85124226663
SN - 1726-4901
VL - 85
SP - 286
EP - 294
JO - Journal of the Chinese Medical Association
JF - Journal of the Chinese Medical Association
IS - 3
ER -