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Comorbidities, race affected mortality, transplant rate in patients with drug-induced liver injury

Race and comorbidities were among important factors that determined death or the need for liver transplantation 6 months after patients were diagnosed with drug-induced liver injury, according to data from a new study.

Data from 991 patients with definite, highly likely or probable drug-induced liver injury (DILI) were collected, and 660 patients (median age, 51.4 years; 59.5% women) were included in the final analysis. Five hundred ninety-eight patients were followed for at least 6 months after baseline without liver transplantation or death, while 62 required a liver transplant (n=30) or died (n=32) within 6 months.

Patients who died or underwent transplantation had a greater mean serum alanine aminotransferase (ALT), total bilirubin, international normalized ratio and model for end-stage liver disease score compared with patients who survived or did not require a transplant, according to data. In addition, those patients also were more likely to have severe acute hepatocellular injury (P<.01).

Of the patients followed for 6 months after DILI onset, 18.9% had persistent liver damage. Patients who were African-American, had prior heart disease, malignancy requiring treatment or high alkaline phosphatase levels were at increased risk for chronic DILI (C-statistic=0.71). Patients of Asian race, those with low serum albumin levels, absence of itching, lung disease, high levels of ALT and total bilirubin were independent risk factors for a shorter time to transplantation or liver-related death (C-statistic=0.87).

“Although our findings are exploratory, confirmation of these findings in other cohorts might allow for improved prognostication in individual patients and inform the design of future therapeutic trials in patients with clinically significant DILI,” the researchers wrote.

Disclosure: See the study for a full list of relevant financial disclosures.