Drug‐induced hepatotoxicity: incidence of abnormal liver function tests consistent with volatile anaesthetic hepatitis in trauma patients

Lin, Jonathan H.; Moore, David H.; Hockey, Brad; Lernia, Rachel Di; Gorelik, Alexandra; Liew, Danny; Nicoll, Amanda

doi:10.1111/liv.12278

Cited by 28 publications

(26 citation statements)

References 23 publications

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“…These inconsistent results could be accounted for by patient severity and referral patterns. Patients reported by Lin et al study had less severe disease whereas several patients reported in the Walsh et al study had hepatic injury and failure.…”

Section: Diagnostic Criteriamentioning

confidence: 82%

“…There is an inconsistent relationship between the severity of skin injury and liver; Lin et al found no significant relationship between skin histopathological findings and liver injury, whereas Walsh et al from Kings College Hospital found patients with DRESS presenting with an atypical erythema multiforme (EM)‐like eruption (purpura and atypical targets) to be associated with severe hepatic involvement such as significantly marked elevation of serum aminotransferases (AST 2758 IU/L) compared with other types of skin pathology (AST 292; P = 0.01). Further, two out of eight patients with EM‐like DRESS died in contrast to one mortality out of 19 cases in the non‐EM‐like DRESS cohort.…”

Section: Diagnostic Criteriamentioning

confidence: 99%

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Drug‐induced liver injury with skin reactions: Drugs and host risk factors, clinical phenotypes and prognosis

Devarbhavi

Raj

2018

Liver International

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While dermatologic manifestations of adverse drug reactions are frequent, drug‐induced liver injury is rare. Numerous drugs are implicated in either Drug‐Induced Liver Injury or Drug‐Induced Skin Injury. However, concomitant Drug‐Induced Liver Injury and Drug‐Induced Skin Injury are uncommon, not well characterized and appear to be caused by a limited number of drugs. These are often associated with immuno‐allergic or hypersensitivity features such as fever, skin rash, blisters or peeling of skin, eosinophilia, lymphadenopathy and mucositis. Liver injury can range from asymptomatic elevation of liver biochemical tests to severe hepatitis and acute liver failure needing liver transplantation. Severe cutaneous adverse reaction, particularly drug reaction with eosinophilia and systemic symptoms is commonly associated with internal organ involvement, the liver being the most frequently involved in approximately 90% of the cases. In Stevens‐Johnson Syndrome/Toxic Epidermal Necrolysis, abnormalities in liver biochemistry tests are common but severe liver disease is rare. There is a strong association of Human Leukocyte Antigen genotype with both drug reaction with eosinophilia and systemic symptoms and Stevens‐Johnson Syndrome/Toxic Epidermal Necrolysis. It is likely that the delayed immune‐mediated reaction triggering skin reaction is also responsible for hepatitis. Drug‐specific lymphocytes are found in the organs involved and also in circulating blood, which along with the cytokines and chemokines play a role in pathogenesis. Anti‐epileptic drugs, allopurinol, sulfonamides, antibiotics and nevirapine are the top five causes of concomitant liver and skin injury. This review will focus on drug and host factors causing concomitant Drug‐Induced Skin Injury and Drug‐Induced Liver Injury and discuss the characteristics of liver involvement in patients with severe cutaneous adverse reaction.

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Section: Diagnostic Criteriamentioning

confidence: 82%

Section: Diagnostic Criteriamentioning

confidence: 99%

Drug‐induced liver injury with skin reactions: Drugs and host risk factors, clinical phenotypes and prognosis

Devarbhavi

Raj

2018

Liver International

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“…Drug‐induced liver injury, or drug‐related hepatotoxicity, is injury to the liver due to exposure to a drug, as demonstrated by impaired liver function tests . Volatile anaesthetics are commonly used inhaled halogenated agents that are a recognised cause of drug‐induced liver injury . Volatile anaesthetic drug‐induced liver injury (VA‐DILI) typically causes a rise in the alanine transaminase (ALT) 2 to 14 days post‐operatively, and can manifest as a spectrum of disease, from asymptomatic derangement in liver biochemistry, to acute severe hepatitis, and rarely, fatal hepatic necrosis …”

Section: Introductionmentioning

confidence: 99%

“…Volatile anaesthetics are primarily metabolised by the cytochrome p450 enzyme, CYP2E1, which generates intermediates that can covalently bind to native cellular components, creating trifluoroacetylated lipid and protein adducts (TFA) . Immune‐mediated drug‐induced liver injury has been demonstrated in patients following modern volatile anaesthetics, but is less common than with halothane or enflurane …”

Section: Introductionmentioning

confidence: 99%

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A prospective study of the incidence of drug‐induced liver injury by the modern volatile anaesthetics sevoflurane and desflurane

Bishop

Hannah

Doyle

et al. 2019

Aliment Pharmacol Ther

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Background: Volatile anaesthetics are known to cause drug-induced liver injury, a hepatotoxic reaction characterised by antibodies to trifluoroacetylated lipid and protein adducts and cytochrome p450 2E1. The incidence of volatile anaesthetic druginduced liver injury from older agents has been described, but modern agents have not been prospectively studied. Aim:To determine prospectively the incidence of volatile anaesthetic drug-induced liver injury from sevoflurane and desflurane.Methods: Adult surgical patients with a predicted post-operative stay of at least 4 days were recruited. If volatile anaesthetic was administered, liver biochemistry was performed regularly. Medications, observations and other investigations were documented. Patients with abnormal liver biochemistry were classified as likely volatile anaesthetic drug-induced liver injury or not based on clinical assessment, Roussel Uclaf Causality Assessment Method score, and the absence of other likely pathology. Some patients were also tested for antibodies to both trifluoroacetylated lipid and protein adducts, and cytochrome p450 2E1. Results:A total of 209 patients were recruited, of which 121 were included for analysis. Post-operative liver biochemistry was abnormal in 62 patients (51.2%); further classified as not volatile anaesthetic drug-induced liver injury in 47 cases (38.8%), and likely volatile anaesthetic-drug induced liver injury in 15 cases (12.4%). Of the likely volatile anaesthetic drug-induced liver injury patients, only one had severe disease with alanine transaminase greater than five times the upper limit of normal, while four cases had moderate disease with alanine transaminase greater than three times the upper limit of normal. Thus, the incidence of clinically significant volatile anaesthetic drug-induced liver injury was 4.1%. No risk factors were identified. Conclusions:Volatile anaesthetic drug-induced liver injury from modern agents seems to be as common (4.1%) as previously reported with older agents (3%), and may identify patients at risk of severe acute liver injury with subsequent re-exposure.

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Causality Assessment Methods in Drug-Induced Liver Injury

Teschke

Danan²

2018

Methods in Pharmacology and Toxicology

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Drug‐induced hepatotoxicity: incidence of abnormal liver function tests consistent with volatile anaesthetic hepatitis in trauma patients

Cited by 28 publications

References 23 publications

Drug‐induced liver injury with skin reactions: Drugs and host risk factors, clinical phenotypes and prognosis

Drug‐induced liver injury with skin reactions: Drugs and host risk factors, clinical phenotypes and prognosis

A prospective study of the incidence of drug‐induced liver injury by the modern volatile anaesthetics sevoflurane and desflurane

Causality Assessment Methods in Drug-Induced Liver Injury

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