Drug-induced Liver Injury Caused by Intravenously Administered Medications: The Drug-induced Liver Injury Network Experience
Drug-induced Liver Injury Caused by Intravenously Administered Medications: The Drug-induced Liver Injury Network Experience
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DOI：
10.1097/mcg.0b013e318276bf00
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发表时间：
2013-07-01
影响因子：
2.9
通讯作者：
Chalasani, Naga
中科院分区：
文献类型：
--
作者：
Ghabril, Marwan;Fontana, Robert;Chalasani, Naga
背景和目的：特异质药物性肝损伤（DILI）可由静脉（IV）药物引起，但这些药物引起的DILI的特征尚不清楚。本研究的目的是描述与药物诱导肝损伤网络前瞻性Study.Methods：受试者的临床特征与疑似DILI与IV剂入组的药物诱导肝损伤网络前瞻性Study.Methods：受试者与疑似DILI由于IV药物治疗可能的，高度可能的，或明确的死亡率scoreswere eligible.Results：在2004年至2010年10月，542例DILI被裁定的因果关系，其中32例有资格纳入本研究。27例受试者的DILI归因于单一IV药物，5例受试者归因于多种IV药物。最常涉及的是抗菌药物（62%）、抗微生物剂（16%）和苯妥英（9%）。肝损伤的类型为肝细胞性30%，混合性33%，胆汁淤积性37%。丙氨酸氨基转移酶（ALT）、碱性磷酸酶（AlkP）和总胆红素峰值分别为686 +/- 915 U/L、623 +/- 563 U/L和8.7 +/- 10.3 mg/dL。ALT、AlkP和总胆红素峰值改善50%的持续时间分别为25 +/- 37、59 +/- 69和20 +/- 28天。DILI严重程度为轻度37%，中度47%，重度13%，致死性3%，无肝移植。5例受试者的因果关系被裁定为明确，17例受试者的因果关系被裁定为非常可能，10例受试者的因果关系被裁定为很可能。结论：抗菌药物和抗菌药物是引起药物性肝损伤的最常见的静脉药物。归因于IV药物的DILI相对罕见，但其结局与总体药物性肝损伤网络队列的结局相似。
Background and Aims:Idiosyncratic drug-induced liver injury (DILI) can be caused by intravenous (IV) medications, but the characteristics of DILI caused by these agents are not known. The aim of this study is to characterize the clinical features of subjects with suspected DILI associated with IV agents enrolled into the Drug Induced Liver Injury Network Prospective Study.Methods:Subjects with suspected DILI due to IV medications with probable, highly likely, or definite casuality scores were eligible.Results:Between 2004 and October 2010, 542 cases of DILI were adjudicated for causality, of which 32 were eligible for inclusion in this study. DILI was ascribed to a single IV agent in 27 subjects, and to multiple IV agents in 5 subjects. Antimicrobial agents (62%), antineoplastic agents (16%), and phenytoin (9%) were most commonly implicated. The pattern of liver injury was hepatocellular in 30%, mixed in 33%, and cholestatic in 37%. The peak alanine aminotransferase (ALT), alkaline phosphatase (AlkP), and total bilirubin were 686 +/- 915 U/L, 623 +/- 563 U/L, and 8.7 +/- 10.3 mg/dL, respectively. The duration for 50% improvement from peak ALT, AlkP, and total bilirubin were 25 +/- 37, 59 +/- 69, and 20 +/- 28 days, respectively. DILI severity was mild in 37%, moderate in 47%, severe in 13%, and fatal in 3%, with no liver transplantation. Their causality was adjudicated as definite in 5, very likely in 17, and probable in 10 subjects. The frequency of chronic DILI was 13%.Conclusions:Antimicrobial and antineoplastic agents are the most common IV agents to cause DILI. DILI ascribed to IV agents is relatively infrequent, but its outcomes are similar to those of the overall Drug Induced Liver Injury Network cohort.