The predictors of complications in patients with drug‐induced liver injury caused by antimicrobial agents

Aliment Pharmacol Ther 31 , 1200–1207

Summary

Background Antimicrobials are the leading cause of idiosyncratic drug‐induced liver injury in most series. Aim To determine the incidence and the predictors of complications in patients with drug‐induced liver injury caused by antimicrobial agents requiring hospitalization. Methods Medical records of patients with drug‐induced liver injury caused by antimicrobial agents were identified by ICD‐10, for the period between 2002 and 2006. Clinical information and blood tests during hospitalization were recorded. The causality assessment of drug‐induced liver injury was determined by the Roussel UCLAF causality assessment method (RUCAM) scale. Results Of 47 594 in‐patient admissions per year, the annual incidence of drug‐induced liver injury was 0.03%. Male: female ratio was 7:3 with a median age of 47 years. Eighty reactions of drug‐induced liver injury were caused by anti‐tuberculosis drugs (85%) and by antibiotics (15%). The median (IQR) of RUCAM scale was 6 (5–8). A total of 36% had HIV infection and 9% of patients had diabetes mellitus. Median (IQR) duration of hospitalization was 9 (5–15) days. Serious complications and death were found in 27.5% and 26%, respectively. By a multivariable logistic analysis, the presence of jaundice was found to be significantly associated with an unfavourable outcome. Conclusion Although rare, antimicrobial agents‐related drug‐induced liver injury requiring hospitalization has a high mortality rate. The presence of jaundice predicts poor outcome.