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Presentations, Causes and Outcomes of Drug-Induced Liver Injury in Egypt
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Presentations, Causes and Outcomes of Drug-Induced Liver Injury in Egypt
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Journal Article
Presentations, Causes and Outcomes of Drug-Induced Liver Injury in Egypt
2020
Overview
Drug-induced liver injury (DILI) is a frequent cause of liver injury and acute liver failure. We aimed to review all hospitalized DILI cases in a tertiary Egyptian center from January 2015 through January 2016. Cases with elevated alanine aminotransferase more than 3-fold and/or alkaline phosphatase more than 2-fold the upper limit of normal value were prospectively recruited and followed for one year. Drug history, liver biopsy whenever feasible and application of Roussel Uclaf Causality Assessment Method (RUCAM) were the diagnostic prerequisites after exclusion of other etiologies of acute liver injury. In order of frequency, the incriminated drugs were: Diclofenac (31 cases, 41.3%), amoxicillin-clavulanate (14 cases, 18.7%), halothane toxicity (8 cases, 10.7%), ibuprofen (4 cases, 5.3%), Khat (3 cases, 4%), tramadol (3 cases, 4%), Sofosbuvir with ribavirin (2 cases, 2.7%), and acetylsalicylic acid (2 cases, 2.7%) with one offending drug in 93.3% of cases. Forty-four cases (58.7%) were males; while 56 cases (74.7%) had HCV related chronic liver disease. Thirty-two cases (42.7%) presented with pattern of hepatocellular injury, while 23 cases (30.7%) were with cholestasis, and 20 cases (20.7%) with a mixed hepatocellular/cholestatic injury. One case received a transplant (0.75%), 7 cases died (9.3%), 23 cases (30.6%) developed liver decompensation (hepatic encephalopathy and ascites), and 44 cases completely resolved (58.7%). In conclusion, Diclofenac is the commonest offender in DILI occurrence in an Egyptian cohort. Age and prothrombin concentration were the only predictors of unfavorable outcomes of DILI.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
/ 13/21
/ Adult
/ Alanine
/ Alanine Transaminase - blood
/ Alkaline Phosphatase - blood
/ Amoxicillin-Potassium Clavulanate Combination - adverse effects
/ Anti-Bacterial Agents - adverse effects
/ Ascites
/ Biopsy
/ Chemical and Drug Induced Liver Injury - mortality
/ Chemical and Drug Induced Liver Injury - pathology
/ Cholestasis - chemically induced
/ Cyclooxygenase Inhibitors - adverse effects
/ Diclofenac - adverse effects
/ Egypt
/ Female
/ Hepatic Encephalopathy - chemically induced
/ Hepatic Encephalopathy - pathology
/ Humanities and Social Sciences
/ Humans
/ Liver
/ Liver Failure, Acute - chemically induced
/ Liver Failure, Acute - pathology
/ Male
/ Nonsteroidal anti-inflammatory drugs
/ Science
/ Toxicity
/ Tramadol
