Translating new knowledge on drug-induced liver injury into clinical practice

Characterization of acute-on-chronic liver diseases: A multicenter prospective cohort study

BACKGROUND

Acute-on-chronic liver disease (AoCLD) accounts for the majority of patients hospitalized in the Department of Hepatology or Infectious Diseases.

AIM

To explore the characterization of AoCLD to provide theoretical guidance for the accurate diagnosis and prognosis of AoCLD.

METHODS

Patients with AoCLD from the Chinese Acute-on-Chronic Liver Failure (ACLF) study cohort were included in this study. The clinical characteristics and outcomes, and the 90-d survival rate associated with each clinical type of AoCLD were analyzed, using the Kaplan-Meier method and the log-rank test.

RESULTS

A total of 3375 patients with AoCLD were enrolled, including 1679 (49.7%) patients with liver cirrhosis acute decompensation (LC-AD), 850 (25.2%) patients with ACLF, 577 (17.1%) patients with chronic hepatitis acute exacerbation (CHAE), and 269 (8.0%) patients with liver cirrhosis active phase (LC-A). The most common cause of chronic liver disease (CLD) was HBV infection (71.4%). The most common precipitants of AoCLD was bacterial infection (22.8%). The 90-d mortality rates of each clinical subtype of AoCLD were 43.4% (232/535) for type-C ACLF, 36.0% (36/100) for type-B ACLF, 27.0% (58/215) for type-A ACLF, 9.0% (151/1679) for LC-AD, 3.0% (8/269) for LC-A, and 1.2% (7/577) for CHAE.

CONCLUSION

HBV infection is the main cause of CLD, and bacterial infection is the main precipitant of AoCLD. The most common clinical type of AoCLD is LC-AD. Early diagnosis and timely intervention are needed to reduce the mortality of patients with LC-AD or ACLF.

Highlighting the Use of the Hepatoprotective Nutritional Supplements among Patients with Chronic Diseases

Cross-sectional studies, while not considered glamorous endeavors, are firmly anchored in data and statistics, providing essential insights about public health. The aim of the study is to see the frequency of hepatoprotective (HP) nutritional supplement consumption among patients with chronic diseases (other than chronic liver disorders) and analyzes the habits related to the consumption of nutritional supplements among these patients. A total of 954 patients, seeking medical prescriptions for chronic diseases under various payment arrangements (compensated, gratuity, or full payment) were carefully selected over a 12-month period from four private pharmaceutical facilities. We examined the frequency of HP consumption in relation with a number of prescribed medications for chronic conditions. All these patients were invited to complete a questionnaire about their supplement consumption habits and were provided the option to participate in a nutritional status assessment. One hundred ninety-five patients consented to participate in the survey, and 65 patients agreed to undergo a nutritional status evaluation. Of the 954 patients, 77.2% incorporate HP into their regimen. The most frequent consumption (83.33%) was recorded in a group with seven drugs, followed by a group with three drugs (82.84%). Women have a higher usage rate of HP (80.58%; 444 from 551) compared to men (62.60%; 293 from 383), and most of the patients (59.5%) used extracts of Silybum marianum L. In the survey, 64.61% of participants were using supplements, with most (59.52%) consuming HP. Only 32.54% of patients rely on recommendations from healthcare professionals. Of the patients who use supplements, 55.56% reported improvements in their health status. Furthermore, patients who integrate supplements into their daily routine tend to achieve better overall nutritional status.

[Drug toxic hepatopathy - an underestimated danger]

Drug-induced toxic hepatopathies and drug-induced liver injury, DILI, are characterized by a variety of clinical manifestations and therefore represent a significant diagnostic challenge. This article shows how DILI is diagnosed and what therapy options exist. Current special cases of DILI genesis are also discussed (DOACs, IBD drugs, tyrosine kinase inhibitors). These newer substances and corresponding hepatotoxic effects are not yet fully understood. The internationally recognized and online available RUCAM score (Roussel Uclaf Causality Assessment Method) helps to assess the probability of drug-related toxic liver damage.

Chronic Drug-Induced Liver Injury: Updates and Future Challenges

Chronic drug-induced liver injury (DILI), defined as DILI with persistent liver injury more than one year after the first onset by the latest European guidelines, is a notable challenge globally with big issues of defining causality and establishing effective treatment. About 20% of patients with DILI develop into chronic DILI. Chronic DILI manifests as persistent or repeated inflammatory or diminishing bile ducts, even progresses to cirrhosis and needs liver transplantation eventually. However, research on chronic DILI over the last decades is still lacking, and the incidence, phenotypes, mechanisms, risk factors, and treatment have not been fully understood. In this paper, we reviewed the definition of chronic DILI, updated clinical studies in terms of incidence, special manifestations, and promising risk factors of chronic DILI, along with the recent progress and challenges in glucocorticoid therapy.

Sleep disorders are associated with acetaminophen-induced adverse reactions and liver injury

Risk factors related to the development of acetaminophen (APAP)-induced adverse reactions and liver injury remain uncertain. Sleep disorders have been linked to some health outcomes. This study examined the associations of sleep disorders with APAP-induced adverse reactions or liver injury and the possible mechanisms. From NIS database, adverse reactions, liver injury and sleep disorders were identified. Factors associated with the risk of the total adverse effects or liver injury were examined with logistic regression. From Gene Expression Omnibus database, datasets GSE111828, containing transcriptome data based on RNA-seq analysis from liver samples extracted from mice post APAP administration, and GSE92913, containing transcriptome data based on microarray analysis from liver samples extracted from mice with sleep deprivation, were analyzed. A total of 4372754 patients without and 91314 patients with sleep disorders were eligible for analyses. Both before and after propensity score matching, APAP-induced adverse reactions were higher in patients with sleep disorders than in patients without. In multivariate regression, sleep disorders were associated with higher odds of APAP-induced adverse reactions (adjusted OR [aOR] 2.005, 95 % CI 1.343-2.995) and liver injury (aOR 2.788, 95 % CI 1.310-5.932). Genes that were enriched in bile secretion and retinol metabolism and PPAR signaling pathways were basically down-regulated in livers of mice after APAP administration and livers of mice with sleep deprivation. This study shows that sleep disorders may be novel independent risk factors for APAP-associated adverse reactions and liver injury and provides bioinformation linking sleep disorders to increased risk of APAP-induced liver injury.