A survey of the drug-induced liver injury cases during the past 16 years in Department of Medicine, Teikyo University Hospital

Background: Recently, the cases of drug-induced liver injury have been increasing due to aging, the increase of kinds of the drugs and patients taking many agents. In the present study, we surveyed the cases of drug-induced liver injury in our department.

Methods: We surveyed the cases that were diagnosed as drug-induced liver injury and admitted to Teikyo University Hospital during 1997-2012. The types of liver injury, causal drugs and the diagnostic scale scores established in DDW-J 2004 were examined, and were compared between the patients in early period (1997-2006) and those in late period (2007-2012).

Results: The total of 112 cases (45 males and 67 females) were classified to 76 cases (68 %) of hepatocellular type, 23 cases (21 %) with mixed type and 13 cases (11%) with cholestatic type according to the type of liver injury. No difference between the patients in early period and those in late period were detected in age, the types of liver injury, severity of injury, and the therapy. Although the sensitivity of drug-induced lymphocyte stimulation test was 28 %, the positive rate in late period was significant higher than that in early period (p=0.003). Sensitivity of the diagnosis using diagnostic scale scores was very high (probable : 86 %, possible : 97 96), and no significant difference was detected between those in early and late period. The rate of psychological drug became significantly less frequent (8 % and 1 %, respectively, p=0.03), and the late of herbal medicine became significantly more frequent (3 % and 10 96, respectively, p=0.04) in causal drug in patients in late period.

Conclusions: Because we surveyed only the cases admitted due to the possibility of drug-induced liver injury, many cases presented marked hepatocellular damage with symptoms such as general malaise or jaundice. In addition, the diagnostic scale for drug-induced liver injury was shown to be useful to diagnose these patients, whereas drug-induced lymphocyte stimulation test was not efficient. As for the causal drugs, rate of psychological drugs revealed to be decreased significantly, and that of herbal medicine, to be significantly increased.