Etiology of new-onset jaundice:: How often is it caused by idiosyncratic drug-induced liver injury in the united states?
Etiology of new-onset jaundice:: How often is it caused by idiosyncratic drug-induced liver injury in the united states?
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DOI：
10.1111/j.1572-0241.2006.01019.x
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发表时间：
2007-03-01
影响因子：
9.8
通讯作者：
Chalasani, Naga
中科院分区：
文献类型：
--
作者：
Vuppalanchi, Raj;Liangpunsakul, Suthat;Chalasani, Naga
背景与目的：急性药物性肝损伤（DILI）的流行病学在美国尚未得到很好的研究。为了更好地了解急性DILI的流行病学，我们在一家非转诊社区医院对新发黄疸的成年人进行了一项研究。方法：回顾性研究了印第安纳州Wishard纪念医院5年间（1999-2003）新发黄疸的成年门诊和住院患者（>= 18岁）。使用我们的电子病历系统识别新发黄疸患者，并审查个人病历以提取所需的临床数据。新发黄疸的定义是，在既往没有总胆红素3 mg/dL的患者中，出现血清总胆红素3 mg/dL。结果：共有732名符合条件的成年人组成了我们的研究队列。脓毒症或血流动力学改变导致假定的缺血性肝损伤是黄疸最常见的单一原因（22%）。非酒精性病因导致的急性肝病导致97例（13%）患者出现新发黄疸，66例（9%）患者出现急性病毒性肝炎，29例（4%）患者出现DILI。大多数DILI病例是由对乙酰氨基酚毒性引起的，特异性DILI仅发生在5例患者中（0.7%）。在发生特异性DILI的患者中，6周未观察到死亡率。结论：在社区医院中，特异性DILI是新发黄疸的罕见病因。
BACKGROUND AND AIM: The epidemiology of acute drug-induced liver injury (DILI) in the United States has not been well studied. We conducted a study of adults with new-onset jaundice at a nonreferral community hospital to better understand the epidemiology of acute DILI.METHODS: This is a retrospective study of adult outpatients and inpatients (>= 18 yr) with new-onset jaundice over a 5-yr period (1999-2003) at Wishard Memorial Hospital, Indiana. Patients with new-onset jaundice were identified using our electronic medical record system and individual medical records were reviewed to extract the required clinical data. New-onset jaundice was defined as the presence of total serum bilirubin > 3 mg/dL in patients without a prior total bilirubin > 3 mg/dL.RESULTS: A total of 732 eligible adults constituted our study cohort. Sepsis or altered hemodynamic state resulting in presumed ischemic liver injury is the single most common cause of jaundice (22%). Acute liver disease as a result of nonalcoholic etiologies caused new-onset jaundice in 97 patients (13%), with acute viral hepatitis in 66 patients (9%) and DILI in 29 patients (4%). Most cases of DILI were as a result of acetaminophen toxicity with idiosyncratic DILI occurring in only five patients (0.7%). No mortality was observed at 6 wk in patients who developed idiosyncratic DILI.CONCLUSION: Idiosyncratic DILI appears to be a rare cause of new-onset jaundice in a community hospital setting.