Population-representative incidence of drug-induced acute liver failure based on an analysis of an integrated health care system.
Population-representative incidence of drug-induced acute liver failure based on an analysis of an integrated health care system.
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DOI：
10.1053/j.gastro.2015.02.050
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发表时间：
2015-06
期刊：
影响因子：
29.4
通讯作者：
Lo Re V 3rd
中科院分区：
文献类型：
--
作者：
Goldberg DS;Forde KA;Carbonari DM;Lewis JD;Leidl KB;Reddy KR;Haynes K;Roy J;Sha D;Marks AR;Schneider JL;Strom BL;Corley DA;Lo Re V 3rd
药物是美国急性肝衰竭（ALF）的主要原因，但没有基于人群的研究评估药物性肝损伤的ALF发生率。我们的目的是确定在一个综合医疗保健系统中药物诱导的ALF的发生率和结局，该系统近似于基于人群的队列。我们使用2004年1月1日至2010年12月31日期间来自Kaiser Permanente北方加州（KPNC）医疗保健系统的数据进行了一项回顾性队列研究。我们纳入了所有年龄≥18岁、加入KPNC ≥6个月并因潜在ALF住院的KPNC成员。主要结局是药物诱导的ALF（定义为凝血障碍和肝性脑病，无基础慢性肝病），由肝病学家确定，他们审查了所有KPNC成员的病历，住院诊断和实验室标准提示潜在的ALF。在2004年至2010年期间的5，484，224名KPNC成员中，669名有住院诊断和实验室标准，表明可能存在ALF。在病历审查后，62例（9.3%）被归类为明确或可能的ALF，32例（51.6%）有药物诱导的病因（27例明确，5例可能）。18起事件（56.3%）涉及对乙酰氨基酚，6起事件（18.8%）涉及膳食/草药补充剂，2起事件（6.3%）涉及抗菌剂，6起事件（18.8%）涉及其他药物。1例对乙酰氨基酚诱导的ALF患者死亡（5.6%; 0.06起事件/1，000，000人-年），3例非对乙酰氨基酚诱导的ALF患者死亡（21.4%; 0.18/1，000，000人-年）。总体而言，6例患者（18.8%）接受了肝移植，22例患者（68.8%）未经移植出院。任何明确的药物诱导的ALF和对乙酰氨基酚诱导的ALF的发生率分别为1.61起事件/1，000，000人-年（95%置信区间，1.06-2.35）和1.02起事件/1，000，000人-年（95%置信区间，0.59-1.63）。药物引起的ALF并不常见，但非处方药和膳食/草药补充剂是其最常见的原因。
Medications are a major cause of acute liver failure (ALF) in the US, but no population-based studies have evaluated the incidence of ALF from drug-induced liver injury. We aimed to determine the incidence and outcomes of drug-induced ALF in an integrated healthcare system that approximates a population-based cohort. We performed a retrospective cohort study using data from the Kaiser Permanente Northern California (KPNC) healthcare system between January 1, 2004 and December 31, 2010. We included all KPNC members ≥18 y old with ≥6 months of membership and hospitalization for potential ALF. The primary outcome was drug-induced ALF (defined as coagulopathy and hepatic encephalopathy without underlying chronic liver disease), determined by hepatologists who reviewed medical records of all KPNC members with inpatient diagnostic and laboratory criteria suggesting potential ALF. Among 5,484,224 KPNC members between 2004 and 2010, 669 had inpatient diagnostic and laboratory criteria indicating potential ALF. After medical record review, 62 (9.3%) were categorized as having definite or possible ALF, and 32 (51.6%) had a drug-induced etiology (27 definite, 5 possible). Acetaminophen was implicated in 18 events (56.3%), dietary/herbal supplements in 6 (18.8%), antimicrobials in 2 (6.3%), and miscellaneous medications in 6 (18.8%). One patient with acetaminophen-induced ALF died (5.6%; .06 events/1,000,000 person-years) compared to 3 patients with non-acetaminophen induced ALF (21.4%; .18/1,000,000 person-years). Overall, 6 patients (18.8%) underwent liver transplantation, and 22 patients (68.8%) were discharged without transplantation. The incidence rates of any definite drug-induced ALF and acetaminophen-induced ALF were 1.61 events/1,000,000 person-years (95% confidence interval, 1.06–2.35) events and 1.02 events/1,000,000 person-years (95% confidence interval, 0.59–1.63), respectively. Drug-induced ALF is uncommon, but over-the-counter products and dietary/herbal supplements are its most common causes.
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影响因子：
9.8
作者：
Laine, Loren;Goldkind, Lawrence;Cannon, Christoper P.
通讯作者：
Cannon, Christoper P.
影响因子：
4.2
作者：
Bailey, Regan L.;Gahche, Jaime J.;Picciano, Mary Frances
通讯作者：
Picciano, Mary Frances
影响因子：
9.8
作者：
Bower, William A.;Johns, Matthew;Bell, Beth P.
通讯作者：
Bell, Beth P.
影响因子：
9.8
作者：
Jinjuvadia, Kartik;Kwan, Wendy;Fontana, Robert J.
通讯作者：
Fontana, Robert J.
影响因子：
39.2
作者：
Chalasani N;Vuppalanchi R;Navarro V;Fontana R;Bonkovsky H;Barnhart H;Kleiner DE;Hoofnagle JH
通讯作者：
Hoofnagle JH