TY - JOUR
T1 - Drug-Induced Acute-on-Chronic Liver Failure in Asian Patients
AU - Devarbhavi, Harshad
AU - Choudhury, Ashok Kumar
AU - Sharma, Manoj Kumar
AU - Maiwall, Rakhi
AU - Al Mahtab, Mamun
AU - Rahman, Salimur
AU - Chawla, Yogesh K.
AU - Dhiman, Radha K.
AU - Duseja, Ajay
AU - Taneja, Sunil
AU - Ning, Qin
AU - Jia, Ji Dong
AU - Duan, Zhongping
AU - Yu, Chen
AU - Eapen, Chundamannil E.
AU - Goel, Ashish
AU - Tan, Soek Siam
AU - Hamid, Saeed Sadiq
AU - Butt, Amna Subhan
AU - Jafri, Wasim
AU - Kim, Dong Joon
AU - Hu, Jinhua
AU - Sood, Ajit
AU - Midha, Vandana
AU - Shukla, Akash
AU - Ghazinian, Hasmik
AU - Sahu, Manoj Kumar
AU - Treeprasertsuk, Sombat
AU - Lee, Guan Huei
AU - Lim, Seng Gee
AU - Lesmana, L. A.
AU - Lesmana, Cosmas Rinaldi
AU - Shah, Samir
AU - Kalal, Chetan
AU - Abbas, Zaigham
AU - Sollano, Jose D.
AU - Prasad, V. G.Mohan
AU - Payawal, Diana Alacantra
AU - Dokmeci, A. Kadir
AU - Rao, P. Nagaraja
AU - Shrestha, Ananta
AU - Lau, George K.
AU - Yuen, Man Fung
AU - Saraswat, Vivek A.
AU - Shiha, Gamal
AU - Yokosuka, Osamu
AU - Kedarisetty, Chandan Kumar
AU - Jain, Priyanka
AU - Bhatia, Puja
AU - Sarin, Shiv K.
N1 - Publisher Copyright:
© 2019 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Acute insults from viruses, infections, or alcohol are established causes of decompensation leading to acute-on-chronic liver failure (ACLF). Information regarding drugs as triggers of ACLF is lacking. We examined data regarding drugs producing ACLF and analyzed clinical features, laboratory characteristics, outcome, and predictors of mortality in patients with drug-induced ACLF.METHODS:We identified drugs as precipitants of ACLF among prospective cohort of patients with ACLF from the Asian Pacific Association of Study of Liver (APASL) ACLF Research Consortium (AARC) database. Drugs were considered precipitants after exclusion of known causes together with a temporal association between exposure and decompensation. Outcome was defined as death from decompensation.RESULTS:Of the 3,132 patients with ACLF, drugs were implicated as a cause in 329 (10.5%, mean age 47 years, 65% men) and other nondrug causes in 2,803 (89.5%) (group B). Complementary and alternative medications (71.7%) were the commonest insult, followed by combination antituberculosis therapy drugs (27.3%). Alcoholic liver disease (28.6%), cryptogenic liver disease (25.5%), and non-alcoholic steatohepatitis (NASH) (16.7%) were common causes of underlying liver diseases. Patients with drug-induced ACLF had jaundice (100%), ascites (88%), encephalopathy (46.5%), high Model for End-Stage Liver Disease (MELD) (30.2), and Child-Turcotte-Pugh score (12.1). The overall 90-day mortality was higher in drug-induced (46.5%) than in non-drug-induced ACLF (38.8%) (P = 0.007). The Cox regression model identified arterial lactate (P < 0.001) and total bilirubin (P = 0.008) as predictors of mortality.DISCUSSION:Drugs are important identifiable causes of ACLF in Asia-Pacific countries, predominantly from complementary and alternative medications, followed by antituberculosis drugs. Encephalopathy, bilirubin, blood urea, lactate, and international normalized ratio (INR) predict mortality in drug-induced ACLF.
AB - Acute insults from viruses, infections, or alcohol are established causes of decompensation leading to acute-on-chronic liver failure (ACLF). Information regarding drugs as triggers of ACLF is lacking. We examined data regarding drugs producing ACLF and analyzed clinical features, laboratory characteristics, outcome, and predictors of mortality in patients with drug-induced ACLF.METHODS:We identified drugs as precipitants of ACLF among prospective cohort of patients with ACLF from the Asian Pacific Association of Study of Liver (APASL) ACLF Research Consortium (AARC) database. Drugs were considered precipitants after exclusion of known causes together with a temporal association between exposure and decompensation. Outcome was defined as death from decompensation.RESULTS:Of the 3,132 patients with ACLF, drugs were implicated as a cause in 329 (10.5%, mean age 47 years, 65% men) and other nondrug causes in 2,803 (89.5%) (group B). Complementary and alternative medications (71.7%) were the commonest insult, followed by combination antituberculosis therapy drugs (27.3%). Alcoholic liver disease (28.6%), cryptogenic liver disease (25.5%), and non-alcoholic steatohepatitis (NASH) (16.7%) were common causes of underlying liver diseases. Patients with drug-induced ACLF had jaundice (100%), ascites (88%), encephalopathy (46.5%), high Model for End-Stage Liver Disease (MELD) (30.2), and Child-Turcotte-Pugh score (12.1). The overall 90-day mortality was higher in drug-induced (46.5%) than in non-drug-induced ACLF (38.8%) (P = 0.007). The Cox regression model identified arterial lactate (P < 0.001) and total bilirubin (P = 0.008) as predictors of mortality.DISCUSSION:Drugs are important identifiable causes of ACLF in Asia-Pacific countries, predominantly from complementary and alternative medications, followed by antituberculosis drugs. Encephalopathy, bilirubin, blood urea, lactate, and international normalized ratio (INR) predict mortality in drug-induced ACLF.
UR - http://www.scopus.com/inward/record.url?scp=85067375262&partnerID=8YFLogxK
U2 - 10.14309/ajg.0000000000000201
DO - 10.14309/ajg.0000000000000201
M3 - Article
C2 - 31021832
AN - SCOPUS:85067375262
SN - 0002-9270
VL - 114
SP - 929
EP - 937
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 6
ER -