Abstract
Introduction Drug-induced liver injury (DILI) is the most common cause
of acute liver failure in the USA, and a major cause of medication
discontinuation. However, DILI is often under-diagnosed, primarily due
to the lack of agreed upon diagnostic criteria and limiting coding
nomenclature. Previous attempts to address these issues have met with
only partial success. Methods We conducted a retrospective observational
analysis of demographic, clinical, and laboratory data for 55 patients
hospitalized in an Israeli tertiary care medical center between
2005-2017 and diagnosed with DILI. Results We identified 55 patients
hospitalized with DILI over 12 years. DILI was associated with female
gender, and more patients were ≥ 50 years of age. Hepatocellular liver
injury was the most common type of liver injury (49.0%). Common
clinical manifestations included fever (41.8%), weakness (41.8%) and
jaundice (34.5%). The major offending drug group was antibiotics
(35.0%) with amoxicillin and clavulanate the most common single drug
within the group (7.2%). Most cases were caused by drugs administered
orally (84%), while most cholestatic injury was seen with intravenous
administration. De Ritis ratio (AST/ALT) was above 1.0 in 75% of cases.
Conclusions Most DILI was caused by oral antibiotics. The incidence of
DILI in our study was low, possibly due to under-diagnosis or
misclassification. The adoption of the updated international
classification of disease 10th edition (ICD-10) may improve reporting
rates. Utilization of the De Ritis ratio may help to differentiate
between DILI and viral hepatitis.