Abstract

Background: Drug-induced liver injury (DILI) is a significant cause of morbidity and mortality worldwide. Understanding the spectrum of DILI in tertiary hospitals is essential for effective management and prevention strategies. Materials and Methods: A retrospective analysis was conducted on patients diagnosed with DILI admitted to a tertiary hospital between January 2018 and November 2023. Demographic data, implicated drugs, clinical presentation, laboratory findings, and outcomes were analyzed. Results: Among 250 patients diagnosed with DILI, the mean age was 52 years , with a slight male predominance (55%). The most commonly implicated drug classes were antibiotics (32%), nonsteroidal anti-inflammatory drugs (NSAIDs) (25%), and herbal supplements (18%). Clinical presentation varied widely, with jaundice (65%), fatigue (52%), and abdominal pain (45%) being the most common symptoms. Laboratory investigations revealed elevated alanine transaminase (ALT) (mean: 856 U/L), aspartate transaminase (AST) (mean: 724 U/L), and total bilirubin (mean: 8.5 mg/dL). Liver biopsy was performed in 40% of cases, showing patterns consistent with hepatocellular injury (45%), cholestatic injury (35%), and mixed injury (20%). Management included discontinuation of the offending agent (100%), supportive care, and, in severe cases, liver transplantation (5%). Mortality rate was 8%. Conclusion: DILI presents with diverse clinical manifestations and laboratory findings. Prompt recognition, withdrawal of the offending agent, and supportive care are crucial in management. A multidisciplinary approach involving hepatologists, pharmacists, and clinicians is necessary for optimal patient outcomes.

Description

Drug-induced liver injury (DILI) is a significant public health concern, contributing to substantial morbidity and mortality worldwide (1). It encompasses a wide spectrum of liver abnormalities, ranging from asymptomatic elevation of liver enzymes to fulminant hepatic failure requiring liver transplantation (2). DILI can result from a variety of medications, including antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), herbal supplements, and chemotherapeutic agents (3). The incidence and severity of DILI vary depending on factors such as the individual's genetic predisposition, dose and duration of drug exposure, and the presence of underlying liver disease (4). Understanding the epidemiology, clinical manifestations, and outcomes of DILI is crucial for clinicians to promptly recognize and manage this condition. Tertiary hospitals often encounter complex cases of DILI due to the referral of patients with severe liver injury or uncertain diagnoses (5). Despite advancements in diagnostic techniques and treatment modalities, DILI remains a diagnostic challenge, requiring a high index of suspicion and a comprehensive evaluation to establish the causative agent (6). This retrospective study aims to delineate the spectrum of DILI in a tertiary hospital setting, focusing on demographic characteristics, implicated drugs, clinical presentation, laboratory findings, histopathological features, management strategies, and outcomes. The findings of this study can provide valuable insights into the epidemiology and clinical course of DILI, facilitating early recognition, appropriate management, and preventive measures to minimize the burden of this potentially life-threatening condition.