The incidence, presentation, outcomes, risk of mortality and economic data of drug-induced liver injury from a national database in Thailand: a population-base study

Abstract

BackgroundToxic liver diseases are mainly caused by drug-induced liver injury (DILI). We assessed incidences and outcomes of DILI including associated factors for mortality.MethodsWe performed a population-based study of hospitalized patients with DILI. Information was retrieved from the Nationwide Hospital Admission Data using ICD-10 code of toxic liver diseases (K71) and additional codes (T36–T65). The associated factors were analyzed with log-rank test, univariate and multiple cox regression analysis.ResultsDuring 2009–2013, a total of 159,061 (average 21,165 per year) admissions were related to liver diseases. 6,516 admissions (1,303 per year) were due to toxic liver diseases. The most common type of toxic liver disease was acute hepatitis (33.5 %). In-hospital and 90-day mortality rates were 3.4 % and 17.2 %. DILI with cirrhosis yielded the highest in-hospital and 90-day mortality rates (15.8 % and 47.4 %). Acetaminophen, cirrhosis and age ≥ 60 years were seen in 0.5 %, 8.3 % and 50.1 % of patients who died versus 5 %, 2.3 % and 32.4 % of survivors. Factors associated with mortality were cirrhosis (HR 2.72, 95 % CI: 2.33–3.19), age ≥60 years (HR 2.16, 95 % CI: 1.96–2.38), human immunodeficiency viral infection (HR 2.11, 95 % CI: 1.88–2.36), chronic kidney disease (HR 1.59, 95 % CI: 1.33–1.90), chronic obstructive pulmonary disease and bronchiectasis (HR 1.55, 95 % CI: 1.17–2.04), malnutrition (HR 1.43, 95 % CI: 1.10–1.86) and male (HR 1.31, 95 % CI: 1.21–1.43). Acetaminophen DILI yielded lower risks of mortality (HR 0.24, 95 % CI: 0.13–0.42). The most common causes of DILI were acetaminophen (35.0 %) and anti-tuberculous drugs (34.7 %).ConclusionsDILI is an uncommon indication for hospitalization carrying lower risks of death except in patients with non-acetaminophen, cirrhosis, elderly or concomitant diseases.

Presentations, Causes and Outcomes of Drug-Induced Liver Injury in Egypt

“…Similar to our study, Devarbhavi et al had reported DILI contributed to 1.4% of all gastrointestinal admissions and 2.5% of hepatobiliary admissions over one year 18 . In a Thailand study; 1.2% of admissions was due to DILI 19 . The results of Meier et al, 2005 were with 1.4% DILI occurrence in hospitalized patients in Switzerland 20 .…”

Systematic review and meta‐analysis of algorithms used to identify drug‐induced liver injury (DILI) in health record databases

“…Estimations of population‐based incidence rates ranged from 13.9 cases per 100 000 inhabitants in France to 19.1 cases per 100 000 inhabitants in Iceland. Rates of DILI are higher in hospitalized patients, ranging from 0.12 to 1.4 per 100 admissions . Although DILI is rare, the consequences could be severe.…”

A significant cancer burden and high mortality of intrahepatic cholangiocarcinoma in Thailand: a nationwide database study

“…This NHSO database is nationwide study, and its coverage of at least of 67.6% of the population of Thailand in 2013 and this database were used and validate in several studies including disease burden of cirrhosis, drug induced liver injury and liver abscess [12–14]. Most of ICC patients presented with advanced stages by their clinical findings and complications.…”