Brief Article
Copyright ©2012 Baishideng Publishing Group Co.
World J Gastroenterol. Nov 7, 2012; 18(41): 5972-5978
Published online Nov 7, 2012. doi: 10.3748/wjg.v18.i41.5972
Table 1 Characteristics of patients with alanine aminotransferase > 10 upper limit of normal range (mean ± SD)
Causesn (%)Age (yr)Female n (%)Peak ALT values (× ULN)
Hemodynamic injury46 (25.7)54.2 ± 17.2a14 (30.4)32.5 ± 30.7b
Drug-induced liver injury25 (19.4)45.4 ± 16.89 (36.0)14.5 ± 5.6
Malignancy21 (16.3)55.8 ± 14.6a2 (9.5)17.5 ± 10.3
Biliary abnormality15 (11.6)52.3 ± 14.47 (46.7)14.3 ± 7.7
Viral hepatitis12 (9.3)47.8 ± 16.84 (33.3)18.6 ± 10.0
Undetermined and others10 (7.8)42.9 ± 12.05 (50)30.9 ± 33.5a
Total129 (100)51.1 ± 16.441 (31.8)23.0 ± 22.7
P (between different causes)-0.0850.150.004
Table 2 Demographic, clinical and laboratory parameters of 25 cases of drug-induced liver injury
VariablesOutcome
RecoveryImprovement
Age, yr44.6 ± 18.445.9 ± 16.4
Female3 (30)6 (40)
Body mass index, kg/m224.3 ± 1.621.6 ± 2.8
Alcohol use2 (20)1 (6.7)
Jaundice2 (20)2 (13.3)
Extrahepatic manifestations
Rash1 (10)1 (6.7)
Fever6 (60)6 (40)
Cytopenia2 (20)4 (26.7)
Incident cases6 (60)11 (73.3)
Surgical wards5 (50)9 (60)
Laboratory parameters, peak values
Alanine aminotransferase (U/L)623 ± 118808 ± 348a
Aspartate aminotransferase (U/L)338 ± 187636 ± 651
Alkaline phosphatase (U/L)169 ± 172167 ± 75
Total bilirubin (mg/dL)1.4 ± 1.61.1 ± 1.0
γ-glutamyl transpeptidase (U/L)190 ± 224213 ± 149
Hepatocellular type9 (90)14 (93.3)
Causality assessment
Highly probable01 (6.7)
Probable9 (90)10 (66.7)
Possible1 (10)4 (26.7)
Time to onset, d5.3 ± 3.88.9 ± 10.2
Time to enzymes resolution, d6.7 ± 2.46.0 ± 3.0
Number of adjunctive drugs2.6 ± 1.62.5 ± 0.8
Adjunctive drugs for treatment
Anti-inflammation7 (70)14 (93.3)
Antioxidants7 (70)11 (61.1)
Phospholipids6 (60)7 (46.7)
Herbs03 (20.0)
Time from treatment of liver injury to discharge, d28 ± 128 ± 6a
Table 3 Implicated causative chemical drugs in 25 subjects with drug-induced liver injury
Classification (n)Specific drugs (n)
Proton pump inhibitors (2)Omeprazole (2)
Cardiovascular system (3)Amiodarone (1), atorvastatin (1), cinepazide (1), telmisartan (1)
Glucocorticoids (6)Methylprednisolone (5), dexamethasone (1)
Antibacterials for systemic use (8)Furbenicillin (2), cefminox (2), ornidazole (2), panipenem and betamipron (2), meropenem (1), piperacillin and sulbactam (1), cefoxitin (1)
Monoclonal antibodies (1)Bevacizumab (1)
Musculo-skeletal system (4)Diclofenac (1), celecoxib (1), parecoxib (1), baclofen (1)
Nervous system (2)Olanzapine (2), fluoxetine (1)
Table 4 Characteristics of 6 cases of drug-induced liver injury caused by glucocorticoids
Age/sexPrincipal diseaseDrugDose (mg/d)Treatment duration (d)Peak values
Follow-up
ALT (U/L)AST (U/L)AP (U/L)TB (mg/dL)GGT (U/L)
20/FSLEMP20-16084600138832.31183Recovered
36/FChronic glomerulonephritisMP32-401710854391620.3441Improved
25/MBrain traumaMP20105152571480.61446Improved
49/MBrain traumaMP40105163631081.19190Improved
42/FDrug eruptionMP30-16024668341100.61146Improved
49/MBrain tumorDXM5-15126022822310.52424Improved
Table 5 Adjunctive drugs used for treatment of drug-induced liver injury
Classification (n)Specific drugs (n)
Anti-inflammation (21)Diammonium glycyrrhizinate (9), magnesium isoglycyrrhizinate (8), compound monoammonium glycyrrhetate S (4), compound glycyrrhizin (3)
Antioxidants (18)Glutathione (17), ademetionine 1,4-butanedisulfonate (6), tiopronin (1)
Phospholipids (13)Polyene phosphatidyl choline (13)
Herbal extrats (3)Protoporphyrin disodium (2), silymarin (1)