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- Title
Drug-induced liver injury in Australia, 2009-2020: the increasing proportion of non-paracetamol cases linked with herbal and dietary supplements.
- Authors
Nash, Emily; Sabih, Abdul‐Hamid; Chetwood, John; Wood, Georgette; Pandya, Keval; Yip, Terry; Majumdar, Avik; McCaughan, Geoffrey W; Strasser, Simone I; Liu, Ken; Sabih, Abdul-Hamid
- Abstract
<bold>Objective: </bold>To compare the characteristics and outcomes of drug-induced liver injury (DILI) caused by paracetamol and non-paracetamol medications, particularly herbal and dietary supplements.<bold>Design: </bold>Retrospective electronic medical record data analysis.<bold>Setting, Participants: </bold>Adults admitted with DILI to the Gastroenterology and Liver Centre at the Royal Prince Alfred Hospital, Sydney (a quaternary referral liver transplantation centre), 2009-2020.<bold>Main Outcome Measures: </bold>90-day transplant-free survival; drugs implicated as causal agents in DILI.<bold>Results: </bold>A total of 115 patients with paracetamol-related DILI and 69 with non-paracetamol DILI were admitted to our centre. The most frequently implicated non-paracetamol medications were antibiotics (19, 28%), herbal and dietary supplements (15, 22%), anti-tuberculosis medications (six, 9%), and anti-cancer medications (five, 7%). The number of non-paracetamol DILI admissions was similar across the study period, but the proportion linked with herbal and dietary supplements increased from 2 of 13 (15%) during 2009-11 to 9 of 19 (47%) during 2018-20 (linear trend: P = 0.011). Despite higher median baseline model for end-stage liver disease (MELD) scores, 90-day transplant-free survival for patients with paracetamol-related DILI was higher than for patients with non-paracetamol DILI (86%; 95% CI, 79-93% v 71%; 95% CI, 60-82%) and herbal and dietary supplement-related cases (59%; 95% CI, 34-85%). MELD score was an independent predictor of poorer 90-day transplant-free survival in both paracetamol-related (per point increase: adjusted hazard ratio [aHR], 1.19; 95% CI, 1.09-3.74) and non-paracetamol DILI (aHR, 1.24; 95% CI, 1.14-1.36).<bold>Conclusion: </bold>In our single centre study, the proportion of cases of people hospitalised with DILI linked with herbal and dietary supplements has increased since 2009. Ninety-day transplant-free survival for patients with non-paracetamol DILI, especially those with supplement-related DILI, is poorer than for those with paracetamol-related DILI.
- Subjects
DIETARY supplements; DRUG side effects; LIVER injuries; OVERALL survival; ELECTRONIC health records
- Publication
Medical Journal of Australia, 2021, Vol 215, Issue 6, p261
- ISSN
0025-729X
- Publication type
journal article
- DOI
10.5694/mja2.51173