DILI Is an Important Cause of Hepatocellular and Mixed Liver Injury—A Nationwide Prospective Study on Elevated Liver Enzymes

IF 5.2 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2025-09-04 DOI:10.1111/liv.70327

S. S. Sigurdarson, H. K. Bjornsson, B. L. Snorrason, E. S. Bjornsson

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Abstract

Background and Aims

Very few prospective studies have investigated the most common causes of concomitant elevation of ALT and ALP. We aimed to investigate the most common aetiologies of hepatocellular or cholestatic liver injury, and to study the proportion of patients with DILI.

Methods

A 2-year prospective study, in Landspitali Hospital, Iceland on patients with (A) ALT > 500 and (B) ALT > 250 U/L and ALP > 210 U/L. Appropriate diagnostic work-up was undertaken. Causality assessment in suspected DILI was with RECAM and expert opinion.

Results

A total of 835 patients were identified with: ALT > 500 U/L (n = 500) or ALT > 250 and ALP > 210 (n = 318), 17 were excluded due to a lack of information or elevations of non-liver related causes. Among 818 patients: 451 females (55%), median age 58 (IQR 40–72). The most common causes were choledocholithiasis 42%, ischaemic hepatitis (IH) 17%, hepato-biliary cancer (HBC) 8.4%, DILI 8.2%, viral hepatitis 6.2%, other aetiologies 11% and unknown aetiologies in 7.8%. IH was significantly more common in Group A but HBC in Group B. DILI was similar in both groups. Amoxicillin-clavulanate, checkpoint inhibitors, herbal-dietary supplements (HDS) and paracetamol were the major causative agents in DILI patients. IH and HBC patients had the highest mortality. Two DILI patients died of liver failure and one patient needed emergency liver transplantation associated with HDS.

Conclusions

The most common cause in both groups was choledocholithiasis. IH was associated with hepatocellular injury whereas HBC was associated with cholestatic injury. DILI was an important aetiology with 8% prevalence in the cohort and was similar in the two groups.

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DILI是肝细胞性和混合性肝损伤的重要原因——肝酶升高的全国前瞻性研究

背景和目的很少有前瞻性研究调查ALT和ALP同时升高的最常见原因。我们的目的是调查肝细胞性或胆汁淤积性肝损伤最常见的病因，并研究DILI患者的比例。方法对冰岛Landspitali医院(A) ALT > 500、(B) ALT > 250 U/L、ALP >； 210 U/L患者进行为期2年的前瞻性研究。进行了适当的诊断检查。用RECAM和专家意见对疑似DILI的因果关系进行评估。结果共有835例患者被确定为：ALT >； 500 U/L （n = 500）或ALT >； 250和ALP >； 210 (n = 318)， 17例因信息缺乏或非肝脏相关原因升高而被排除。818例患者中：女性451例（55%），中位年龄58岁（IQR 40-72）。最常见的原因是胆总管结石42%，缺血性肝炎（IH） 17%，肝胆癌（HBC） 8.4%, DILI 8.2%，病毒性肝炎6.2%，其他原因11%，未知原因7.8%。IH在A组中更为常见，而HBC在b组中更为常见。阿莫西林-克拉维酸酯、检查点抑制剂、草药膳食补充剂（HDS）和扑热息痛是DILI患者的主要病原体。IH和HBC患者死亡率最高。2例DILI患者死于肝功能衰竭，1例患者因HDS需要紧急肝移植。结论两组最常见的病因均为胆总管结石。IH与肝细胞损伤相关，而HBC与胆汁淤积性损伤相关。DILI是一个重要的病因，在队列中患病率为8%，在两组中相似。

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来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.