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Ma X, Chen Z, An J, Zhang C. Clinical Features and Risk Factors for Drug-Induced Liver Injury: A Retrospective Study From China. Clin Ther 2024:S0149-2918(24)00106-1. [PMID: 38821767 DOI: 10.1016/j.clinthera.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/20/2024] [Accepted: 04/30/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE With the prolongation of human life expectancy and the outbreak of COVID-19, antineoplastic agents, anti-infective drugs, and cardiovascular system drugs have been widely applied, resulting in a growing incidence of drug-induced liver injury (DILI) year by year. This study aimed to investigate signals, clinical characteristics, and risk factors in patients with liver injury. METHODS A retrospective analysis was conducted on inpatients clinically diagnosed with DILI from 2019 to 2021 in one tertiary hospital in mainland China. The hepatic biochemical indices, clinical manifestations and suspected drugs of the patients were counted. We determined causality assessed by the Roussel Uclaf Causality Assessment Method in patients that the biochemistry met the diagnostic criteria recommended by the International Serious Adverse Events Consortium and compared them with contemporaneous patients diagnosed as DILI but with hepatic biochemical abnormalities only to identify the injure types and risk factors for DILI. FINDINGS A total of 1167 patients from 2639 initial participants with DILI were included. According to the injured target cells, it can be divided into hepatocellular injury type 351 cases (30.08%), cholestatic injury type 97 cases (8.31%), mixed injury type 27 cases (2.31%), and biochemical abnormal only type 692 cases (59.30%). It involved 1738 cases of suspected drugs, 349 drugs, and the top 3 drug categories were antineoplastic agents, anti-infectives, and traditional Chinese medicines, with Cyclophosphamide, Atorvastatin, and Liuzasulfapyridine as the top 3 in order of ranking. The main symptoms of patients were darker urine, decreased appetite, and yellow sclera. The overall prognosis of patients with DILI was favorable, with 280 recovered cases (23.99%), 691 improved cases (59.21%), 189 not improved cases (16.20%), and 7 deaths (0.60%). There were significant differences in gender, age, malignancy, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, gamma-glutamyltransferase, albumin, international normalized ratio, and prognosis among patients with different injury types (P < 0.05). Multiple logistic regression analysis showed that female (odds ratio [OR] = 1.897, P < 0.001), alcohol use (OR = 1.905, P = 0.001), malignancy (OR = 0.417, P < 0.001), and pregnancy (OR = 0.201, P = 0.011) were independent factors influencing DILI. IMPLICATIONS For most patients with liver injury, the manifestations are mild elevation of liver biochemistry without other symptoms (biochemical abnormal only type). The rest of the patients are predominantly of the hepatocellular injury type. Female and alcohol abuse patients are the risk factors of DILI, reminding clinicians to strengthen education on safe drug use, give individualized treatment, and regularly monitor liver function indexes in the patients.
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Affiliation(s)
- Xiaojuan Ma
- Department of Clinical Pharmacy, Third Hospital of Hebei Medical University, Shijiazhuang City, China
| | - Zhuo Chen
- Department of Clinical Pharmacy, Third Hospital of Hebei Medical University, Shijiazhuang City, China
| | - Jingzhi An
- Department of Clinical Pharmacy, Third Hospital of Hebei Medical University, Shijiazhuang City, China
| | - Cuixin Zhang
- Department of Clinical Pharmacy, Third Hospital of Hebei Medical University, Shijiazhuang City, China.
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Lee B, Xiong S, Westen EA, Warner JA. Chronic Drug-Induced Liver Injury from Labetalol during the Postpartum Period: A Case Report. AJP Rep 2024; 14:e43-e47. [PMID: 38269129 PMCID: PMC10805563 DOI: 10.1055/a-2209-4636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 10/20/2023] [Indexed: 01/26/2024] Open
Abstract
Drug-induced liver injury (DILI) is a common cause of transaminitis in pregnancy. A 34-year-old G3P2012 presented 3 weeks postpartum for preeclampsia with severe features. After receiving acute antihypertensive medications, she was discharged home with labetalol. She presented 5 months later with general malaise, scleral icterus, nausea, and mild right upper quadrant pain and found to have significantly elevated transaminitis. She had a negative infectious, autoimmune, biliary, and steatohepatitis workup. A liver biopsy was performed supporting the diagnosis of DILI. After patient self-discontinued labetalol, her hepatitis significantly improved. However, she developed chronic DILI and liver enzymes normalized during her subsequent pregnancy at 34 weeks. Patient's written consent was obtained for this case report. Chronic DILI secondary to labetalol use is a rare and potentially fatal condition that should be considered on the differential for transaminitis during pregnancy and postpartum period.
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Affiliation(s)
- Bruce Lee
- Department of Obstetrics and Gynecology, Rochester General Hospital, Rochester, New York
| | - Suriya Xiong
- Department of Pharmaceutical Care – Ambulatory Care, Digestive Health Center, University of Iowa Hospitals & Clinics, Coralville, Iowa
| | - Elizabeth A. Westen
- Department of Maternal-Fetal Medicine, Rochester General Hospital, Rochester, New York
| | - Julie Ann Warner
- Department of Pathology and Laboratory Medicine, Rochester General Hospital, Rochester, New York
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Williamson C, Nana M, Poon L, Kupcinskas L, Painter R, Taliani G, Heneghan M, Marschall HU, Beuers U. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. J Hepatol 2023; 79:768-828. [PMID: 37394016 DOI: 10.1016/j.jhep.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 07/04/2023]
Abstract
Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy. Whether related to pregnancy or pre-existing, liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality. Thus, the European Association for the Study of Liver Disease invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations, based on the best available evidence, for the management of liver disease in pregnancy for hepatologists, gastroenterologists, obstetric physicians, general physicians, obstetricians, specialists in training and other healthcare professionals who provide care for this patient population.
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Fayaz F, Zarban A, Aschner M, Aramjoo H, Roshanravan B, Foadodini M, Abderam A, Samarghandian S, Farkhondeh T. Buprenorphine administration during gestation induces hepatotoxicity in the rat fetus. Can J Physiol Pharmacol 2023; 101:74-79. [PMID: 36621961 DOI: 10.1139/cjpp-2022-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study investigated the effect of buprenorphine (BUP) on the livers of pups exposed to this drug during the fetal stage. BUP decreased the activities of serum liver enzymes in exposed animals versus the controls. BUP (0.5 mg/kg) decreased malondialdehyde levels and increased the glutathione levels in the liver of animals versus other groups. The superoxide dismutase activity was elevated in the BUP 0.5 mg/kg group versus the control group. BUP (1 mg/kg) induced histopathological changes in the livers of pups. In conclusion, BUP may induce hepatotoxicity in pups exposed to this drug during the fetal stage.
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Affiliation(s)
- Farshid Fayaz
- Student Research Committee, Birjand University of Medical Sciences, Birjand, 9717853577, Iran
| | - Asghar Zarban
- Department of Clinical Biochemistry, School of Medicine, Birjand University of Medical Sciences, Birjand, 9717853577, Iran
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Hamed Aramjoo
- Student Research Committee, Birjand University of Medical Sciences, Birjand, 9717853577, Iran
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences, Birjand, 9717853577, Iran
| | - Mohsen Foadodini
- Department of Physiology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, 9717853577, Iran
| | - Amir Abderam
- Student Research Committee, Birjand University of Medical Sciences, Birjand, 9717853577, Iran
| | - Saeed Samarghandian
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, 9318614139, Iran
| | - Tahereh Farkhondeh
- Department of Toxicology and Pharmacology, School of Pharmacy, Birjand University of Medical Sciences, Birjand, 9717853577, Iran
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Hui SYA, Lao TT. Tuberculosis in pregnancy. Best Pract Res Clin Obstet Gynaecol 2022; 85:34-44. [PMID: 36002371 PMCID: PMC9339097 DOI: 10.1016/j.bpobgyn.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/07/2022] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Abstract
Due to COVID-19 pandemic, the latest progress of the End Tuberculosis (TB) Strategy was far from optimal and services for TB needs to be quickly restored. Pregnancy is a unique opportunity to screen and manage TB, and it is an essential step in TB eradication. Early diagnosis and treatment for active disease can reduce maternal and neonatal morbidities and mortality. The more widespread utilization of newer rapid molecular assays with drug-susceptibility testing has significantly shortened the diagnostic process for active TB disease. First-line anti-TB drugs are proven to be safe in pregnancy. Management of latent TB infection (LTBI) during pregnancy is controversial, but puerperium is a period of increased susceptibility to progress to active disease. Extrapulmonary TB (EPTB), multidrug-resistant TB (MDR-TB) and HIV co-infection remain significant issues surrounding TB management during pregnancy and often require input from a multidisciplinary team including TB experts.
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Affiliation(s)
- Shuk Yi Annie Hui
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Terence T Lao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Ahmad B, Khan W, Haq TU, Ahmad S, Zahoor M, Alotaibi A, Ullah R. Beneficial effects of coconut oil (Cocos nucifera) on hematobiochemicl and histopathological markers in CCL4-intoxicated rabbits. BRAZ J BIOL 2022; 84:e252555. [PMID: 35293540 DOI: 10.1590/1519-6984.252555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
Abstract
The study was designed to investigate the effect of Coconut Oil on the levels of some liver and hematological parameters in carbon tetrachloride intoxicated rabbits. Also the antioxidant capacity of Coconut Oil for various concentrations was assessed on the basis of percent scavenging of (DPPH) free radical. Experimental animals were divided into five groups, eight rabbits in each group. These were: group A (Normal control), group B (Toxic control), group C (Standard control), group D (Treated with Coconut Oil 50 mL/kg body weight after CCl4 intoxication), group E (Treated with Coconut Oil 200 mL/kg body weight after CCl4 intoxication). The effects observed were compared with a standard hepatoprotective drug silymarine (50 mL/kg body weight). The Coconut Oil (200 mL/kg body weight) significantly (P<0.05) reduced the elevated serum levels of alanine transaminase (ALT), aspartate transaminase (AST) and alkaline phosphatase (ALP) when compared to a toxic control rabbits. The results of extract treated rabbits were similar to silymarine administered rabbits group. Treatment with Coconut Oil root and silymarine caused no significant changes in RBC, Platelets, (Hb), (MCH) concentration and (HCT) values. However, significant (P<0.05) increase was observed in the total WBC count. The present study suggested that Coconut Oil can be used as an herbal alternative (need further exploration i.e to detect its bioactive compound and its efficacy) for hepatoprotective activity.
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Affiliation(s)
- B Ahmad
- University of Malakand, Department of Zoology, Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - W Khan
- University of Malakand, Department of Zoology, Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - T U Haq
- University of Malakand, Department of Biotechnology, Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - S Ahmad
- Islamia College Peshawar, Department of Zoology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - M Zahoor
- University of Malakand, Department of Biochemistry, Chakdara, Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - A Alotaibi
- Princess Nourah bint Abdulrahman University, College Of Medicine, Department of Basic Science, Riyadh, Saudi Arabia
| | - R Ullah
- King Saud University, College of Pharmacy, Department of Pharmacognosy, Medicinal Aromatic and Poisonous Plant Research Center, Riyadh, Saudi Arabia
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Contreras Omaña R, Moreno Alcántar R, Cerda Reyes E. Drug-Induced Liver Injury: A Mexican View. Clin Liver Dis (Hoboken) 2022; 19:78-81. [PMID: 35308476 PMCID: PMC8912224 DOI: 10.1002/cld.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Content available: Author Audio Recording.
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Affiliation(s)
- Raúl Contreras Omaña
- Centro de Estudio e Investigación en Enfermedades Hepáticas y ToxicológicasHidalgoMéxico
| | - Rosalba Moreno Alcántar
- Jefe del Servicio de GastroenterologíaCentro Médico Nacional Siglo XXIIMSSCiudad de MéxicoMéxico
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Abstract
Liver disease in pregnancy can be related to a pre-existing condition (such as autoimmune liver disease) or arise as a consequence of pregnancy. In women with pre-existing disease, pre-pregnancy counselling is important to discuss the potential complications that may occur during pregnancy and how best to manage these. Acute fatty liver of pregnancy and HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome are pregnancy-related liver diseases and are considered obstetric emergencies. Women with liver dysfunction need appropriate investigations, including blood tests and imaging. They should be managed as part of a multidisciplinary team with obstetricians, obstetric anaesthetists, specialist midwives, gastroenterologists and obstetric physicians.
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Affiliation(s)
- Elvyna Lim
- Luton and Dunstable University Hospital, Luton, UK.,joint first authors
| | - Maria Mouyis
- Luton and Dunstable University Hospital, Luton, UK .,joint first authors
| | - Lucy MacKillop
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK and honorary senior clinical lecturer, University of Oxford, Oxford, UK
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Zhu Z, Zhang M, Li Y. Anti-tuberculosis drug-induced acute liver failure requiring transplantation in the second trimester of pregnancy: a case report. BMC Pregnancy Childbirth 2021; 21:592. [PMID: 34465292 PMCID: PMC8408989 DOI: 10.1186/s12884-021-04065-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Treatment of tuberculosis (TB) during pregnancy can reduce maternal and foetal complications. However, it may also induce fatal liver injury. Case presentation We present a case of a 26-year-old pregnant woman who underwent orthotopic liver transplantation for anti-TB drug-induced fulminant hepatic failure (FHF). Her tuberculous pleurisy was treated with rifampin, isoniazid and pyrazinamide. An artificial liver support system (ALSS) was unable to reverse the liver injury while serving as a bridge to liver transplantation. She had a successful liver transplantation operation at 17 3/7 weeks of gestation. The foetal ultrasound scan showed mild foetal bilateral ventriculomegaly at 21 5/7 weeks of gestation, and labour was induced via double-balloon catheter as soon as the allograft function was stable. Despite immunosuppression, the TB was well controlled with linezolid, levofloxacin and pyridoxine at the 8 months follow-up. Conclusions Anti-TB drug-induced liver failure during pregnancy is rare. We present a case of successful treatment of FHF in which an artificial liver support system combined with liver transplantation. The FHF was caused by anti-TB drugs with difficulties due to pregnancy status and post-transplant anti-TB treatment. Mild foetal ventriculomegaly was found in our case. Further research is still needed to identify the risks of TB treatment and liver transplantation in pregnant women. A multidisciplinary team coordinated properly to optimize patient outcomes.
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Affiliation(s)
- Zhoufeng Zhu
- Department of Gynecology and Obstetrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, 310003, Hangzhou City, Zhejiang Province, China
| | - Min Zhang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, 310003, Hangzhou City, Zhejiang Province, China
| | - Yang Li
- Department of Gynecology and Obstetrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, 310003, Hangzhou City, Zhejiang Province, China.
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ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury. Am J Gastroenterol 2021; 116:878-898. [PMID: 33929376 DOI: 10.14309/ajg.0000000000001259] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/25/2021] [Indexed: 12/11/2022]
Abstract
Idiosyncratic drug-induced liver injury (DILI) is common in gastroenterology and hepatology practices, and it can have multiple presentations, ranging from asymptomatic elevations in liver biochemistries to hepatocellular or cholestatic jaundice, liver failure, or chronic hepatitis. Antimicrobials, herbal and dietary supplements, and anticancer therapeutics (e.g., tyrosine kinase inhibitors or immune-checkpoint inhibitors) are the most common classes of agents to cause DILI in the Western world. DILI is a diagnosis of exclusion, and thus, careful assessment for other etiologies of liver disease should be undertaken before establishing a diagnosis of DILI. Model for end-stage liver disease score and comorbidity burden are important determinants of mortality in patients presenting with suspected DILI. DILI carries a mortality rate up to 10% when hepatocellular jaundice is present. Patients with DILI who develop progressive jaundice with or without coagulopathy should be referred to a tertiary care center for specialized care, including consideration for potential liver transplantation. The role of systemic corticosteroids is controversial, but they may be administered when a liver injury event cannot be distinguished between autoimmune hepatitis or DILI or when a DILI event presents with prominent autoimmune hepatitis features.
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