Clinical features of patients with different types of acute drug-induced liver injury: A comparative analysis / 临床肝胆病杂志

ObjectiveTo investigate the clinical features of patients with different types of acute drug-induced liver injury (DILI) through a retrospective analysis. MethodsClinical data were collected from 790 patients who were diagnosed with acute DILI in Beijing YouAn Hospital and Beijing Tongren Hospital affiliated to Capital Medical University from December 2010 to March 2019, and according to the type of damaged target cell, the patients were divided into hepatocellular injury type group with 554 patients, cholestasis type group with 99 patients, and mixed type group with 137 patients. The patients were evaluated based on severity grade and score, clinical outcome, and Hy′s rule. An analysis of variance was used for comparison of normally distributed continuous data between three groups, and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups. The chi-square test was used for comparison of categorical data between three groups. The Kruskal-Wallis H test was used for comparison of ranked data between three groups, and the Mann-Whitney U test was used for comparison between two groups. ResultsMost of the patients were female in all three groups, and the hepatocellular injury type group had a significantly higher proportion of female patients than the cholestasis type group (70.8% vs 54.5%, P＜0.05), and the Cholestasis type group had a significantly lower proportion of female patients than the mixed type group(54.5% vs 54.7%, P＜0.05). There were 244 patients with grade 3 hepatocellular injury type DILI (244/554, 44.4%), 56 patients with grade 3 cholestasis type DILI (56/99, 56.6%), and 46 patients with grade 3 mixed type DILI (46/137, 33.6%), and there was a significant difference between the three groups (χ2=36.589, P＜0.05). Drugs inducing liver injury included traditional Chinese medicine, Western medicine, combination of traditional Chinese medicine and Western medicine, and other drugs, among which traditional Chinese medicine was the most common cause of liver injury. There was a significant difference in the outcome at discharge between the patients with different types (H=14.390, P=0.001). Compared with the cholestasis type group, the hepatocellular injury type group had a significantly higher cure rate and significantly lower uncured rate and mortality rate (all P＜0.05). Among the 554 patients with hepatocellular injury type DILI, 388 (70.0%) met Hy′s rule and 166 (300%) did not meet Hy′s rule, and there was a significant difference in clinical outcome between these two groups (U=38 372.0, P=0.033). ConclusionDILI is more common in women, and most patients have hepatocellular injury type DILI. Traditional Chinese medicine is the main cause of liver injury. There is a high proportion of patients with severe DILI among the patients with hepatocellular injury type or cholestasis type. DILI often has good prognosis with a relatively low mortality rate. Hy′s rule cannot predict the death of patients with acute DILI.

Value of Model for End-Stage Liver Disease and Child-Turcotte-Pugh score in predicting the prognosis of patients with hepatic sinus obstruction syndrome associated with Gynura segetum (Lour.) Merr / 临床肝胆病杂志

ObjectiveTo investigate the value of Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) score in predicting the prognosis of patients with hepatic sinusoidal obstruction syndrome (HSOS) associated with Gynura segetum (Lour.) Merr. MethodsA total of 49 patients with HSOS associated with Gynura segetum (Lour.) Merr. who were admitted to Beijing YouAn Hospital, Beijing Ditan Hospital, The Fifth Medical Center of Chinese PLA General Hospital, Tianjin Third Central Hospital, and The First Affiliated Hospital of Xinxiang Medical University from January 2012 to July 2018 were enrolled and followed up for three years, with death as the outcome event. MELD and CTP scores were calculated according to the laboratory examination and clinical data on admission, and according to CTP score, the patients were divided into CTP class A (CTP score 5-6) group(n=8), CTP class B (CTP score 7-9) group(n=23), and CTP class C (CTP score ≥10) group(n=18). The patients were divided into death group(n=12) and survival group(n=37) according to the clinical outcome during follow-up. The Mann-Whitney U test was used for comparison of continuous data between groups, and the Kruskal-Wallis H test was used for ranked data. The area under the receiver operator characteristic (ROC) curve (AUC) was used to investigate the ability of CTP and MELD scores in predicting death. The Kaplan-Meier survival curves were used to determine the long-term prognosis of patients with different CTP and MELD scores, and the log-rank test was used for comparison. The ROC curve was used to evaluate the performance of these two scoring systems in predicting death. ResultsA total of 12 patients died during the 3-year follow-up period. The patients with HSOS had a median MELD score of 13.443 (8.792-18.379), and the death group had a significantly higher MELD score than the survival group ［19.84 (15.49-25.41) vs 11.58 (8.60-15.79), Z=-3.511, P＜0.001］. The patients with HSOS had a CTP score of 6-12, and of all 49 patients, 8 (16.3%) had CTP class A HSOS, 23 (46.9%) had CTP class B HSOS, and 18 (36.7%) had CTP class C HSOS. The mortality rate of the patients increased significantly with the increase in CTP score (χ2=16.078, P＜0.05). The mortality rates of the patients with CTP class A, B, and C HSOS were 0.0%, 13.0%, and 50.0%, respectively (χ2=10343, P＜0.05). The Kaplan-Meier analysis showed that the patients with a MELD score of ＜14.294 4 had a significantly better 3-year prognosis than those with a MELD score of ≥14.294 4 (χ2=14.893, P＜0.001). The higher the CTP score, the poorer the 3-year prognosis of patients (χ2=11.083, P＜0.05). CTP class had an AUC of 0.780 (95% confidence interval ［CI］: 0.639-0.922) in predicting the prognosis of HSOS patients, while MELD score had an AUC of 0.840 (95%CI: 0.722-0.958), and there was no significant difference between the two scores (Z=2.63, P＞0.05). ConclusionBoth MELD and CTP scores can predict the risk of death in patients with HSOS, with similar performance in predicting the prognosis of patients, and further studies are needed to validate their clinical value.

Clinical features, pathogenesis, and diagnosis and treatment of different types of hepatic sinusoidal obstruction syndrome / 临床肝胆病杂志

Hepatic sinusoidal obstruction syndrome (HSOS) is a sinusoidal or small venous fibrous occlusive disease characterized by small hepatic vessel damage, especially sinusoidal endothelial cell injury. Exposure to certain exogenous toxins is the main cause of the disease. Based on etiology, HSOS is mainly classified into pyrrolidine alkaloid-related HSOS, hematopoietic stem cell transplantation-related HSOS, and HSOS of unknown etiology. This article summarizes the types of HSOS and reviews the research advances in clinical manifestations, pathogenesis, diagnosis, and treatment of HSOS.

Clinical types and features of chronicity of drug-induced liver injury / 临床肝胆病杂志

ObjectiveTo investigate the clinical types and features of chronicity of drug-induced liver injury (DILI). MethodsThe patients who were diagnosed with DILI in Beijing You′An Hospital, Capital Medical University from January 2011 to December 2013 were screened, and a retrospective analysis was performed for 84 patients with chronic DILI. The case report form was filled out for each patient, and the data were entered into a database, including demographic features, underlying diseases, types of drugs, cardinal symptoms and signs, and laboratory examinations. ResultsOf all patients, 63 (75.0%) were female. The chronicity of DILI could be divided into six clinical types according to disease progression and recovery of liver function; of all patients, 64 (762%) had a recurrent type, 4 (4.8%) had a delayed recovery type, 4 (4.8%) had a recurrent fluctuation type, 6 (7.1%) had a chronic cholestasis type, 5 (6.0%) had a type of rapid progression to liver cirrhosis, and 1 (1.2%) had a type of drug-induced autoimmune hepatitis. Among all the 84 patients, 56 (66.7%) had underlying diseases; 51 (60.7%) had DILI induced by a single drug, mainly traditional Chinese medicine (47.0%), antipyretics and analgesics (10.6%), and antitubercular agents (9.1%); as for the type of liver injury, 52 (61.9%) had hepatocyte injury, 8 (9.5%) had cholestasis, and 5 (6.0%) had a mixed type. Liver biochemistries showed abnormal results in 19 patients (22.6%). ConclusionThe chronicity of DILI can be divided into six clinical types, of which the most common type is the recurrent type, and the other clinical types include delayed recovery type, recurrent fluctuation type, chronic cholestasis type, rapid progression to liver cirrhosis, and drug-induced autoimmune hepatitis.