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Drug-induced liver injury outcomes similar despite heavy alcohol consumption

Anabolic steroids were the most common cause of drug-induced liver injury among patients with heavy alcohol consumption, according to a recently published study. However, heavy alcohol consumption did not correlate with worse outcomes compared with nondrinkers.

“In an earlier study from the Drug Induced Liver Injury Network (DILIN), alcohol consumption, defined as any alcohol intake in the preceding 12 months, was unexpectedly associated with less severe injury in individuals with DILI,” Lara Dakhoul, MD, from the Indiana University School of Medicine, and colleagues wrote. “In this report we comprehensively examined the relationship between heavy and non-heavy alcohol consumption and causative agents, characteristics and outcomes of liver injury in a large cohort of prospectively enrolled patients with well characterized DILI.”

Dakhoul and colleagues enrolled 1,198 patients with definite, highly likely or probable DILI from the DILIN between September 2004 and April 2016. The three groups had similar rates of causality and proportion of cases.

Overall, 601 patients reported any amount of alcohol consumption in the prior 12 months. Eighty of 348 patients who completed a questionnaire reported heavy consumption. The prevalence of preexisting liver disease, latency to onset of liver injury and pattern of injury at presentation were similar between drinkers and nondrinkers.

Compared with patients without alcohol consumption, anabolic steroids were significantly more likely the cause of DILI (13% vs. 2%; P < .001). Otherwise, the overall injury characteristics, severity and outcomes due to anabolic steroids did not differ significantly between those with heavy alcohol consumption and those without consumption.

Similarly, the frequency of herbal and dietary supplement-induced liver injury was significantly higher in patients with heavy alcohol consumption (21.5% vs. 14.4%; P < .001), but latency to onset and pattern of liver injury at presentation was similar between the two groups.

Patients who reported alcohol consumption had lower DILIN severity scores compared with those without alcohol consumption (2.6 vs. 2.7; P = .032); however, the rates of liver-related mortality or need for liver transplantation and diagnosis of chronic DILI were similar between the two groups.

After the researchers excluded probable DILI cases, they found that while there was no difference in DILIN severity score between heavy drinkers and nondrinkers, heavy drinkers had significantly higher severity scores compared with those who reported mild to moderate consumption (P = .03).

Between heavy drinkers, mild to moderate drinkers and nondrinkers, the researchers observed no significant difference in rates of liver-related mortality, need for liver transplantation or chronic DILI.

“We did not find heavy alcohol consumption to be associated with worse outcomes in patients with DILI,” the researchers concluded. “The higher frequency of liver injury due to anabolic steroids in patients with heavy alcohol consumption may simply represent a behavioral association rather than any pathophysiologic link between the two.” – by Talitha Bennett

Disclosure: Dakhoul reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.