Spectrum of drug-induced liver injury in a tertiary hospital

Abstract

Background: Drug-induced liver injury (DILI) is a significant cause of morbidity and mortality worldwide. Understanding the spectrum of DILI in tertiary hospitals is essential for effective management and prevention strategies.
Materials and Methods: A retrospective analysis was conducted on patients diagnosed with DILI admitted to a tertiary hospital between January 2018 and November 2023. Demographic data, implicated drugs, clinical presentation, laboratory findings, and outcomes were analyzed.
Results: Among 250 patients diagnosed with DILI, the mean age was 52 years , with a slight male predominance (55%). The most commonly implicated drug classes were antibiotics (32%), nonsteroidal anti-inflammatory drugs (NSAIDs) (25%), and herbal supplements (18%). Clinical presentation varied widely, with jaundice (65%), fatigue (52%), and abdominal pain (45%) being the most common symptoms. Laboratory investigations revealed elevated alanine transaminase (ALT) (mean: 856 U/L), aspartate transaminase (AST) (mean: 724 U/L), and total bilirubin (mean: 8.5 mg/dL). Liver biopsy was performed in 40% of cases, showing patterns consistent with hepatocellular injury (45%), cholestatic injury (35%), and mixed injury (20%). Management included discontinuation of the offending agent (100%), supportive care, and, in severe cases, liver transplantation (5%). Mortality rate was 8%.
Conclusion: DILI presents with diverse clinical manifestations and laboratory findings. Prompt recognition, withdrawal of the offending agent, and supportive care are crucial in management. A multidisciplinary approach involving hepatologists, pharmacists, and clinicians is necessary for optimal patient outcomes.