Patients with Drug-induced Liver Injury Caused by Antimicrobial Agents
Patients with Drug-induced Liver Injury Caused by Antimicrobial Agents
Background Antimicrobials are the leading cause of idiosyncratic drug-induced liver injury in most series.
Aim To determine the incidence and the predictors of complications in patients with drug-induced liver injury caused by antimicrobial agents requiring hospitalization.
Methods Medical records of patients with drug-induced liver injury caused by antimicrobial agents were identified by ICD-10, for the period between 2002 and 2006. Clinical information and blood tests during hospitalization were recorded. The causality assessment of drug-induced liver injury was determined by the Roussel UCLAF causality assessment method (RUCAM) scale.
Results Of 47 594 in-patient admissions per year, the annual incidence of drug-induced liver injury was 0.03%. Male: female ratio was 7:3 with a median age of 47 years. Eighty reactions of drug-induced liver injury were caused by anti-tuberculosis drugs (85%) and by antibiotics (15%). The median (IQR) of RUCAM scale was 6 (5–8). A total of 36% had HIV infection and 9% of patients had diabetes mellitus. Median (IQR) duration of hospitalization was 9 (5–15) days. Serious complications and death were found in 27.5% and 26%, respectively. By a multivariable logistic analysis, the presence of jaundice was found to be significantly associated with an unfavourable outcome.
Conclusion Although rare, antimicrobial agents-related drug-induced liver injury requiring hospitalization has a high mortality rate. The presence of jaundice predicts poor outcome.
Idiosyncratic drug-induced liver injury (DILI) is a common cause of acute liver failure in both US (13% of patients) and Sweden (15% of patients). Antimicrobial agents were reported as the aetiology in 45.5% of the patients and were the leading cause of DILI in a recent prospective study in the US as in most other series. Previous study from Spain showed that several antimicrobial agents, including, isoniazid, pyrazinamide, rifampicin, amoxicillin with clavulanic acid and erythromycin were the most common agents associated with acute liver injury attributable to drugs. Risk factors for DILI have been reported to be a previous history of drug reactions, old age, female gender, multiple drugs therapy, immunocompromised hosts, pre-existing liver disease and poor nutritional status. Some high-risk patients such as patients with human immunodeficiency virus (HIV) infection had concomitant medications such as anti-retroviral agents or anti-tuberculosis drugs which were prescribed for their opportunistic infection. Recently, Varma et al. reported that 667 HIV-infected patients with newly diagnosed tuberculosis in Thailand had a 17% mortality rate. Approximately 30% of the nonsurvivors had abnormal liver tests which was more than twice common than in survivors. Thus, liver disease including DILI has a great impact on the prognosis of these patients.
We aimed to determine the incidence and the predictors of complications in patients with DILI caused by antimicrobial agents requiring hospitalization at a tertiary care centre.
Abstract and Introduction
Abstract
Background Antimicrobials are the leading cause of idiosyncratic drug-induced liver injury in most series.
Aim To determine the incidence and the predictors of complications in patients with drug-induced liver injury caused by antimicrobial agents requiring hospitalization.
Methods Medical records of patients with drug-induced liver injury caused by antimicrobial agents were identified by ICD-10, for the period between 2002 and 2006. Clinical information and blood tests during hospitalization were recorded. The causality assessment of drug-induced liver injury was determined by the Roussel UCLAF causality assessment method (RUCAM) scale.
Results Of 47 594 in-patient admissions per year, the annual incidence of drug-induced liver injury was 0.03%. Male: female ratio was 7:3 with a median age of 47 years. Eighty reactions of drug-induced liver injury were caused by anti-tuberculosis drugs (85%) and by antibiotics (15%). The median (IQR) of RUCAM scale was 6 (5–8). A total of 36% had HIV infection and 9% of patients had diabetes mellitus. Median (IQR) duration of hospitalization was 9 (5–15) days. Serious complications and death were found in 27.5% and 26%, respectively. By a multivariable logistic analysis, the presence of jaundice was found to be significantly associated with an unfavourable outcome.
Conclusion Although rare, antimicrobial agents-related drug-induced liver injury requiring hospitalization has a high mortality rate. The presence of jaundice predicts poor outcome.
Introduction
Idiosyncratic drug-induced liver injury (DILI) is a common cause of acute liver failure in both US (13% of patients) and Sweden (15% of patients). Antimicrobial agents were reported as the aetiology in 45.5% of the patients and were the leading cause of DILI in a recent prospective study in the US as in most other series. Previous study from Spain showed that several antimicrobial agents, including, isoniazid, pyrazinamide, rifampicin, amoxicillin with clavulanic acid and erythromycin were the most common agents associated with acute liver injury attributable to drugs. Risk factors for DILI have been reported to be a previous history of drug reactions, old age, female gender, multiple drugs therapy, immunocompromised hosts, pre-existing liver disease and poor nutritional status. Some high-risk patients such as patients with human immunodeficiency virus (HIV) infection had concomitant medications such as anti-retroviral agents or anti-tuberculosis drugs which were prescribed for their opportunistic infection. Recently, Varma et al. reported that 667 HIV-infected patients with newly diagnosed tuberculosis in Thailand had a 17% mortality rate. Approximately 30% of the nonsurvivors had abnormal liver tests which was more than twice common than in survivors. Thus, liver disease including DILI has a great impact on the prognosis of these patients.
We aimed to determine the incidence and the predictors of complications in patients with DILI caused by antimicrobial agents requiring hospitalization at a tertiary care centre.