HIGH PREVALENCE OF DILI/HILI IN A CENTER PARTICIPATING IN A MULTICENTER STUDY FOR DIAGNOSING ACUTE HEPATITIS IN BRAZIL

Introduction and Objectives

Hepatotoxicity caused by drugs and herbs (DILI/HILI) can cause mild to severe lesions. The diagnosis is based on exclusion, and it is essential to investigate the use of drugs and herbal remedies.

To assess the prevalence of DILI/HILI in a multicenter study on acute hepatitis.

Materials and Methods

A cross-sectional, descriptive, and analytical study conducted at a university hospital in Bahia, as part of a national multicenter screening project for acute hepatitis. Patients with clinical suspicion of acute hepatitis were included.

Results

The sample included 50 patients: 17 (34%) with DILI/HILI and 33 (66%) with other etiologies. These included: autoimmune hepatitis 4 (8%), cholestatic syndrome 1(2%), late transplant rejection 1(2%), Chikungunya and Dengue 2(4%), alcoholic hepatitis 1(2%), Caroli syndrome 1 (2%), and biliary cholangiopathy 1(2%). Viral etiologies: hepatitis B 6 (12%), including one case of chronic HBV reactivated by herbal use, hepatitis C 3 (6%), Epstein-Barr virus IgM 5 (10%), and Cytomegalovirus IgM 3 (6%), with one CMV case in the DILI/HILI group. Thirteen cases (26%) had undefined or non-hepatic causes. Two groups were stratified: Group 1 with DILI/HILI (17) and Group 2 without DILI/HILI (33). Median values were calculated for ALT, AST, ALP, GGT, and bilirubin total. Group 1: AST 257 U/L, ALT 313 U/L, GGT 696 U/L, ALP 234 U/L, BT 7.6 mg/dL. Group 2: AST 162 U/L, ALT 109 U/L, GGT 216 U/L, ALP 172 U/L, TB 4.9 mg/dL. AST, ALT, and GGT were higher in the DILI/HILI group. No statistical difference in ALP and BT (p=0.5120; p=0.8057).

Conclusions

DILI/HILI cases showed a more prominent biochemical profile, suggesting more severe liver injury. Careful investigation of drug and herbal use is essential in the evaluation of acute hepatitis.