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Article: Drug-Induced Acute-on-Chronic Liver Failure in Asian Patients

TitleDrug-Induced Acute-on-Chronic Liver Failure in Asian Patients
Authors
KeywordsEnd Stage Liver Disease
Patients
Acute decompensation
Issue Date2019
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at https://journals.lww.com/ajg/pages/default.aspx
Citation
The American Journal of Gastroenterology, 2019, v. 114, p. 929-937 How to Cite?
AbstractAcute 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. © 2019 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited.
Persistent Identifierhttp://hdl.handle.net/10722/275111
ISSN
2017 Impact Factor: 10.231
2015 SCImago Journal Rankings: 3.946

 

DC FieldValueLanguage
dc.contributor.authorDevarbhavi, H-
dc.contributor.authorChoudhury, AK-
dc.contributor.authorSharma, MK-
dc.contributor.authorMaiwall, R-
dc.contributor.authorAI Mahtab, M-
dc.contributor.authorRahman, S-
dc.contributor.authorChawla, YK-
dc.contributor.authorDhimusejaan, RK-
dc.contributor.authorDuseja, A-
dc.contributor.authorTaneja, S-
dc.contributor.authorNing, Q-
dc.contributor.authorJia, JD-
dc.contributor.authorDuan, Z-
dc.contributor.authorYu, C-
dc.contributor.authorEapen, CE-
dc.contributor.authorGoel, A-
dc.contributor.authorTan, SS-
dc.contributor.authorHamid, SS-
dc.contributor.authorButt, AS-
dc.contributor.authorJafri, W-
dc.contributor.authorKim, DJ-
dc.contributor.authorHu, JH-
dc.contributor.authorSood, A-
dc.contributor.authorMidha, V-
dc.contributor.authorShukia, A-
dc.contributor.authorGhazinian, H-
dc.contributor.authorSahu, MK-
dc.contributor.authorTreeprasertsuk, S-
dc.contributor.authorLee, GH-
dc.contributor.authorLim, SG-
dc.contributor.authorLesmana, LA-
dc.contributor.authorLesmana, CR-
dc.contributor.authorShah, S-
dc.contributor.authorKala, C-
dc.contributor.authorAbbas, Z-
dc.contributor.authorSollano, JD-
dc.contributor.authorPrasad, VGM-
dc.contributor.authorPayawa, DA-
dc.contributor.authorDokmeci, AK-
dc.contributor.authorRao, PN-
dc.contributor.authorShrestha, A-
dc.contributor.authorLau, GK-
dc.contributor.authorYuen, RMF-
dc.contributor.authorSaraswa, VA-
dc.contributor.authorShiha, G-
dc.contributor.authorYokosuka, O-
dc.contributor.authorKedarisetty, CK-
dc.contributor.authorJain, P-
dc.contributor.authorBhatia, P-
dc.contributor.authorSarin, SK-
dc.date.accessioned2019-09-10T02:35:40Z-
dc.date.available2019-09-10T02:35:40Z-
dc.date.issued2019-
dc.identifier.citationThe American Journal of Gastroenterology, 2019, v. 114, p. 929-937-
dc.identifier.issn0002-9270-
dc.identifier.urihttp://hdl.handle.net/10722/275111-
dc.description.abstractAcute 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. © 2019 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited.-
dc.languageeng-
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at https://journals.lww.com/ajg/pages/default.aspx-
dc.relation.ispartofThe American Journal of Gastroenterology-
dc.rightsThis is a non-final version of an article published in final form in (provide complete journal citation)-
dc.subjectEnd Stage Liver Disease-
dc.subjectPatients-
dc.subjectAcute decompensation-
dc.titleDrug-Induced Acute-on-Chronic Liver Failure in Asian Patients-
dc.typeArticle-
dc.identifier.emailYuen, RMF: mfyuen@hku.hk-
dc.identifier.authorityYuen, RMF=rp00479-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.14309/ajg.0000000000000201-
dc.identifier.pmid31021832-
dc.identifier.scopuseid_2-s2.0-85067375262-
dc.identifier.hkuros304375-
dc.identifier.volume114-
dc.identifier.spage929-
dc.identifier.epage937-
dc.publisher.placeUnited States-

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