Drug induced liver injury: causative agents and predictors for the outcome – a retrospective study at Tanta University Hospital, Egypt

N.E. Helal, M. Elkadeem, S.M. Elbastawesy, S.A. Mashaal

Department of Forensic Medicine and Clinical Toxicology, Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt. mahmoud.elkadeem@med.tanta.edu.eg

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• Toxicology

OBJECTIVE: Drug induced liver injury is a rare but an important cause of acute liver failure. It is associated with significant morbidity and mortality. This study aimed to analyze this disorder, causes, different patterns, and outcomes in Egyptian patients.

PATIENTS AND METHODS: This retrospective study collected data of 87 patients diagnosed with drug induced liver injury from 2019 through 2020 at Tanta University. Pattern of liver injury was classified as hepatocellular, cholestatic, and mixed. Data including Model for End-Stage Liver Disease (MELD), Glasgow coma scale, and Poison Severity Score were statistically analyzed. Predictors of mortality and fulminant hepatic failure were determined.

RESULTS: Participants were 46 females and 41 males with age ranging from 12-70 years. 39 patients had hepatocellular liver injury, 15 cholestatic, and 33 mixed. Fulminant hepatic failure was diagnosed in 40 patients. Acetaminophen was the most common causative agent. Overall mortality was 17%. Dead patients had significantly deteriorated liver functions (Model for End-Stage Liver Disease). On multivariate logistic regression analysis, Model for End Stage Liver Disease and SO2 independently predicted mortality, and Model for End Stage Liver Disease and random blood glucose were predictors of fulminant hepatic failure development.

CONCLUSIONS: Drug induced liver injury is an important health problem in Egypt. Further studies are needed to know the natural history of this disorder. Acetaminophen is one of the most common leading causes. The MELD score is a useful predictor of the outcome of drug induced liver injury such as fulminant hepatic failure and mortality.

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