Characteristics of Drug-induced Liver Injury in Chronic Liver Disease:Results from the Thai Association for the Study of the Liver(THASL)DILI Registry

Background and Aims:The impact of drug-induced liver injury(DILI)on patients with chronic liver disease(CLD)is unclear.There are few reports comparing DILI in CLD and non-CLD patients.In this study,we aimed to determine the incidence and outcomes of DILI in patients with and without CLD.Methods:We collected data on eligible individuals with suspected DILI between 2018 and 2020 who were evaluated systematically for other etiologies,causes,and the severity of DILI.We compared the causative agents,clinical features,and outcomes of DILI among subjects with and without CLD who were enrolled in the Thai Association for the Study of the Liver DILI registry.Subjects with definite,or highly likely DILI were included in the analysis.Results:A total of 200 subjects diagnosed with DILI were found in the registry.Of those,41 had CLD and 159 had no evidence of CLD in their background.Complementary and alternative medicine(CAM)products were identified as the most common class of DILI agents.Approximately 59%of DILI in the CLD and 40%in non-CLD group were associated with CAM use.Individuals with pre-existing CLD had similar severity including mortality.Twelve patients(6%)developed adverse outcomes related to DILI including seven(3.5%)deaths and five(2.5%)with liver failure.Mortality was 4.88%in CLD and 3.14%in non-CLD subjects over median periods of 58(8–106)days and 22(1–65)days,respectively.Conclusions:In this liver disease registry,the causes,clinical presentation,and outcomes of DILI in subjects with CLD and without CLD patients were not different.Further study is required to confirm our findings.

Prognostic Relevance of Metabolic Dysfunction-associated Steatohepatitis for Patients with Chronic Hepatitis B

Background and Aims:Metabolic dysfunction-associated fatty liver disease(MAFLD)is prevalent in patients with chronic hepatitis B(CHB).The effect of the histologic MAFLD phenotype on long-term CHB outcomes is unknown.We performed a longitudinal study to determine the prognostic relevance of biopsy-proven hepatic steatosis and steatohepatitis for CHB patients.Methods:Clinical and laboratory data were obtained from CHB patients who underwent liver biopsy during 2002–2008 and were treated with antiviral drugs.A hepatopathologist reviewed the biopsy specimens.Cox proportional hazards regression was used to estimate the adjusted hazard ratio(aHR)of outcomes,including all-cause mortality,liver transplantation,and liver-related events.Results:In accordance with Brunt’s classification,408 patients had steatohepatitis(n=34),“steatosis but not steatohepatitis”(n=118),or“non-steatosis”(n=256).All steatohepatitis patients had features of metabolic dysfunction.Over a mean follow-up of 13.8±3.1 years,18 patients died or underwent liver transplantation.In multivariate-adjusted analysis,steatohepatitis(aHR,6.37;95%confidence interval[CI]:1.59–25.5)compared with non-steatosis and advanced fibrosis(aHR,11.3;95%CI:1.32–96.3)compared with no fibrosis were associated with overall mortality/liver transplantation.Thirty-five patients developed 43 liver-related events,among which 32 were hepatocellular carcinoma.These events were associated with steatohepatitis(aHR,5.55;95%CI:2.01–15.3)compared with non-steatosis and advanced fibrosis(aHR,6.23;95%CI:1.75–22.2)compared with no fibrosis.The steatosis but not steatohepatitis group had a nonsignificantly higher risk of overall mortality and liver-related events.Conclusions:Metabolic dysfunction-associated steatohepatitis increased the risk of long-term mortality/transplantation and liver-related events in CHB patients.