Premium
Drug‐induced liver injury is frequently associated with severe cutaneous adverse drug reactions: experience from two Australian tertiary hospitals
Author(s) -
Fang Wendy C.,
Adler Nikki R.,
Graudins Linda V.,
Goldblatt Caitlin,
Goh Michelle S. Y.,
Roberts Stuart K.,
Trubiano Jason A.,
Aung Ar Kar
Publication year - 2018
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.13734
Subject(s) - medicine , toxic epidermal necrolysis , odds ratio , liver injury , retrospective cohort study , liver transplantation , eosinophilia , adverse drug reaction , drug , gastroenterology , surgery , dermatology , transplantation , pharmacology
Background Drug‐induced liver injury (DILI) can be associated with certain cutaneous adverse drug reaction (cADR). Aims To demonstrate the prevalence of DILI in patients with cADRs. Severity and patterns of liver injury, risk factors, causal medications and outcomes are also examined. Methods A retrospective cohort study of patients with cADRs was conducted across two hospitals in Australia. Patients were identified through cross‐linkage of multiple databases. Results One hundred and four patients with cADRs were identified. Of these, 33 (31.7%) had liver injury, representing 50% of patients with drug reaction with eosinophilia and systemic symptoms, and 30.2% of patients with Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). Most cases of liver injury (69.7%) were of a cholestatic/mixed pattern with severe disease in 18.2%. No significant risk factors for development of liver injury were noted, but peripheral lymphocytosis may represent a risk in patients with SJS (odds ratio, OR = 6.0, 95% confidence interval, CI: 1.8–19.7, P = 0.003). Antimicrobials were the most common class to be implicated in DILI. The median length of inpatient stay was longer in patients with liver injury compared to those without (19 vs 11 days, P = 0.002). The mortality rate in those with liver injury was 15.2% and 9.9% in those without. No patients required liver transplantation. Conclusions DILI commonly occurs in patients with cADRs and is associated with longer inpatient stay. Patients with SJS/TEN and peripheral lymphocytosis appear to be at higher risk for developing associated liver injury.