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Inicio Annals of Hepatology OP-3 CLINICAL PRESENTATION AND CAUSATIVE AGENTS OF IDIOSYNCRATIC DRUG-INDUCED LI...
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Vol. 28. Núm. S1.
Abstracts of the 2022 Annual Meeting of the ALEH
(marzo 2023)
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Vol. 28. Núm. S1.
Abstracts of the 2022 Annual Meeting of the ALEH
(marzo 2023)
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OP-3 CLINICAL PRESENTATION AND CAUSATIVE AGENTS OF IDIOSYNCRATIC DRUG-INDUCED LIVER INJURY IN URUGUAY: FIRST DECADE OF EXPERIENCE.
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Nelia Hernandez1, Daniela Chiodi1, Adriana Sanchez1, Laura Reyes2, Ximena Pazos1, María di Pace3, Carla Bianchi4, Yessica Pontet1, Silvia Lissman5, Carmen Pollio6, Lucía Secondo1, Natalie Nabon7, Ana Britos8, Rossana Gaibisso9, Martín Oricchio1, Esteban Delgue10, Fernando Bessone11, Raúl Andrade12, María Isabel Lucena12
1 Gastroenterology Clinic, Clinicas Hospital, University of the Republic, Montevideo, Uruguay
2 Salto Medical Center, Salto, Uruguay
3 Catholic Circle of Workers of Uruguay, Montevideo, Uruguay
4 Mautone Sanatory, Maldonado, Uruguay
5 Personalized Medicine, Montevideo, Uruguay
6 Gastroenterology Department, Hospital Maciel, Montevideo, Uruguay
7 Evangelical Hospital, Montevideo, Uruguay
8 Tacuarembó Medical Corporation, Tacuarembó, Uruguay
9 Uruguayan Medical Doctor, Montevideo, Uruguay
10 Salto Regional Hospital, Salto, Uruguay
11 Gastroenterology Service, Centenary Hospital, National University of Rosario, Rosario, Argentina
12 Digestive System CMU, Clinical Pharmacology Service, Institute of Biomedical Research Institute of Malaga and Nanomedicine Platform-IBIMA. BIONAND Platform, Virgen de la Victoria University Hospital, University of Malaga, CIBERehd. Malaga, Spain
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Vol. 28. Núm S1

Abstracts of the 2022 Annual Meeting of the ALEH

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Introduction and Objectives

Drug-induced liver injury (DILI), usually considered rare, represents a unique challenge. The creation of DILI registries has improved epidemiological understanding and enhanced awareness, which in the absence of specific biomarkers, is essential for a more accurate diagnosis. This study aimed to present a complete analysis of 147 Uruguayan cases with DILI enrolled in the LATINDILI Registry over ten years.

Materials and Methods

Uruguayan patients enrolled in the LATINDILI registry during the last decade were analyzed regarding latency, pattern, severity, evolution, and type of drugs incriminated. Baseline characteristics were described using mean, median, and percentages.

Results

Out of 158 episodes presenting suspected DILI, eleven were excluded for alternative diagnoses or insufficient data, and 147 were finally enrolled into the registry from 2011 to 2021. The mean age was 53 years and 60% were females. Jaundice was present in 55% of the cases; the mean latency was 75 days (1-720). Total bilirubin ranged from 0.19 to 33 mg/dl (mean 4.7), ALT from 32 to 6000 UI/L (mean 630), and AP was between 60 and 3327 UI/L with a median of 520. The hepatocellular injury was the most frequent pattern (58%), and anti-infectives were the most common causative drug class (28%), followed by antineoplastic agents (16%). Amoxicillin clavulanate was the most frequent drug across all patterns of injury. Hospital admission was seen in 51% and complete recovery before one year of follow-up in 73% (10% lost of follow-up). Table 1 describes the demographics, clinical and laboratory parameters according to the type of damage.

Conclusions

This prospective series is the first approximation of the epidemiology of DILI in Uruguay. Beyond its contribution to the LATINDILI registry, it is a priceless tool to identify/highlight local risk factors, causative drugs, and clinical signatures and can impact fostering DILI recognition.

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Table 1: Demographics, clinical and laboratory parameters of the 147 cases of idiosyncratic liver injury according to the type of damage.

  Type of liver damage
variable  Hepatocellular (N=86)  Cholestatic (N= 41)  Mixed (N=20) 
Mean age (range), y  47 (17-89)  65,2 (27-86)  51,5 (18-88) 
Female, n (%)  52 (60)  26 (64,2)  10 (50%) 
Jaundice, n (%)  41 (47,6)  22 (53,6)  12 (60%) 
Hospital admission, n (%)  40 (46,5)  22 (53,6)  13 (65%) 
Mean duration of treatment days (95% CI)  81,4 (53,2-109,7)  77,7 (42,8-112,6)  42,8 (41,1-44,5) 
Mean latency, days (95% CI)  82,1 (53,9-108,5)  77,2 (45,2-109,1)  45,8 (44,1-47,5) 
Total bilirrubin (mg/dl), mean value (range)  4,4 (0,19-33)  5 (0,22-15,7)  5,4 (0,26-29) 
ALT (xULN), mean value (range)  24 (3,2-200,0)  4,37 (0,9-12,9)  9,6 (2,8-23,5) 
AP (ULN), mean value (range)  1,45 (0,4-4,1)  4,6 (1,3-13,6)  2,7 (1-5,8) 
Recovery, days (95% CI)  76,9 (68,9-103,2)  198,7 (103-294,5)  93,9 (92,2-95,7) 
Positive rechallenge, n (%)  9 (10,4)  2 (4,7)  2 (10%) 
Severe, n(%)  12 (13,9) 
Death  1 (1,17)* 
Drug with ≥5 cases  amoxicillin clavulanate (8), diclofenac (6)  amoxicillin clavulanate (13)  amoxicillin clavulanate (5) 
    ibuprofeno (5), metildopa (5)   

Total bilirubin (N<1.0 mg/dl); ALT, alanine transaminase; AP, alkaline phosphatase; ULN, upper limit of normal. Death occurred after positive rechallenge. Laboratory values are those at presentation.

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