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The progression of chronicity and autoimmune hepatitis in recurrent drug-induced liver injury - 24/11/22

Doi : 10.1016/j.clinre.2022.102009 
Tingting He a, 1, Lutong Ren b, c, d, 1, Man Gong a, 1, Yuming Guo b, c, Liping Wang a, Xiaohe Xiao b, c, , Ruilin Wang a, , Zhaofang Bai b, c,
a Department of Hepatology Medicine of Traditional Chinese Medicine, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China 
b Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China 
c China Military Institute of Chinese Materia, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China 
d Department of Pharmacy, Inner Mongolia People's Hospital, Hohhot, China 

Corresponding author.

Highlights

There has been no published systematic research on the topic of recurrent DILI, chronic liver injury and AIH.
Our study registry of patients with DILI was searched for the same patients who experienced a second DILI episode, and we investigated the characteristics and prognosis of patients with recurrent DILI and compared liver injury indicators between patients with AIH and patients who did not progress to AIH, as well as the proportion of patients with chronicity for both episodes.
An insight into the clinical features predictive of recurrence, chronicity and AIH might help to predict effectiveness of therapy, guide treatment strategy and control relapse.

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Abstract

Background and aims

Recurrent drug-induced liver injury (DILI) is not well documented. We retrospectively analysed the characteristics of patients who had a history of two separate DILI episodes due to different drugs.

Methods

We collected data from 57 patients with recurrent DILI from 9582 confirmed DILI cases. Demographic, laboratory, and clinical data from both episodes were collected and analysed to determine the relationship between recurrent DILI, chronic DILI, and autoimmune hepatitis (AIH).

Results

The incidence rate of recurrent DILI in our cohort was 0.59%. Most of the 57 patients with recurrent DILI were female (73.68%). The latency period of the initial episode was 30 days, whereas that of the second episode was 13 days (P = 0.003). The pattern of liver injury was not significantly different between episodes (P = 0.52). Laboratory indicators, such as alanine aminotransferase, aspartate transaminase, alkaline phosphatase, and total bilirubin, were significantly lower in the second episode than in the initial episode (P < 0.05). The incidence of chronic DILI was 43.86% during the initial episode and increased to 63.16% during the second episode. After the initial episode, 15 patients developed AIH during the second episode.

Conclusions

The latency period of recurrent DILI was gradually shortened. The clinical indices of liver injury tended to be less elevated during the second episode. Female post-menopausal patients with abnormal serum immunoglobulin G levels may be predisposed to AIH. The second DILI episode was more likely to have features of AIH.

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Keywords : Recurrent DILI, Chronic DILI, Autoimmune hepatitis, Prognosis, Clinical features

Abbreviations : ALP, ALT, AST, ANA, ASMA, BMI, Chol, GGT, GLU, HC, IgG, LFT, Mixed, RUCAM, TBIL, TC, TCM


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© 2022  The Author(s). Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 46 - N° 10

Article 102009- décembre 2022 Retour au numéro
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