Clinical features of patients with drug-induced liver injury in China in the last five years

Objective To investigate the clinical features of patients with drug-induced liver injury ( DILI) in China in the last five years.Methods Related databases were searched for original case reports on DILI in China published from January 2012 to December 2017, and a total of 202 articles with 26 015 DILI patients were included in this analysis. Sex, age, geographical distribution, causative drugs, clinical features, and prognosis were summarized and analyzed. Categorical data were expressed as rate ( %) or constituent ratio. Results Of all 26 015 patients, 12 885 ( 49. 53%) were male and 13 130 ( 50. 47%) were female, with a mean age of 46. 86 years. The five most common causative drugs were traditional Chinese medicine ( TCM) ( 34. 68%) , anti-tubercular agents ( 15. 81%) , anti-microbial drugs ( 12. 04%) , antitumor drugs ( 9. 09%) , and analgesic-antipyretic drugs ( 6. 17%) . Major clinical manifestations included fatigue ( 50. 37%) , jaundice ( 52. 68%) , and poor appetite ( 43. 59%) . A total of 158 articles recorded the typing of 19994 DILI patients, among whom 58. 84% had the hepatocellular type, 21. 79% had the cholestasis type, and 19. 37% had the mixed type. Liver biopsy had a certain value in the diagnosis of DILI. Major therapies for DILI included withdrawal of suspected drugs, anti-inflammatory treatment, and liver protection. A total of 179 articles reported the prognosis of 22 030 patients, among whom 11 159 ( 50. 65%) were cured, 8742 ( 39. 68%) were improved, 1176 ( 5. 34%) had no response, and 353 patients ( 1. 60%) died. Conclusion There is a similar incidence rate of DILI between male and female populations. TCM is the most common causative drugs for DILI. The hepatocellular type is the most common clinical type. The cured and improved rate is as high as 90. 34%, and most patients have good prognosis.