Potentially hepatotoxic drugs are still being prescribed to liver disease patients under tertiary care: it is time to say enough

Introduction and aim: Drug-induced liver injury (DILI) manifests as a spectrum of clinical presentations that carries morbidity and mortality. Patients with chronic liver disease (CLD), particularly hospitalized, are at high risk for developing DILI. We aimed to investigate the use of potentially h...

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Autores principales:	Rodrigo Dorelo, Samantha T.A. Barcelos, Magela Barros, Valeria Elustondo, Ysela Y.P. Pérez, Martin Oricchio, Nelson D.S. Uribe, Nelia Hernandez, Dvora Joveleviths, Mario R. Alvares-da-Silva
Formato:	article
Lenguaje:	ES
Publicado:	Universidad Nacional Hermilio Valdizán 2021
Materias:	liver diseases drug-induced liver injury acute-on-chronic liver failure acute liver failure Medicine (General) R5-920 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/fb1f743af31b4897baa9eeffeb7230e6
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spelling	oai:doaj.org-article:fb1f743af31b4897baa9eeffeb7230e62021-11-04T23:08:27ZPotentially hepatotoxic drugs are still being prescribed to liver disease patients under tertiary care: it is time to say enough10.35839/repis.5.4.11042616-6097https://doaj.org/article/fb1f743af31b4897baa9eeffeb7230e62021-10-01T00:00:00Zhttp://revistas.unheval.edu.pe/index.php/repis/article/view/1104https://doaj.org/toc/2616-6097 Introduction and aim: Drug-induced liver injury (DILI) manifests as a spectrum of clinical presentations that carries morbidity and mortality. Patients with chronic liver disease (CLD), particularly hospitalized, are at high risk for developing DILI. We aimed to investigate the use of potentially hepatotoxic drugs (PHD) in patients with CLD in a tertiary university hospital. Materials and methods: Adult (≥ 18 years-old) with CLD admitted to the hospital from January 2016 to December 2018 were evaluated regarding PHD, assessing the risk of DILI and liver enzymes behavior after exposure. Results: From 931 hospitalized patients with CLD, 291 (31.3%) were exposed to hepatotoxic drugs during their hospitalization. Of those, 244 (83.8%) were cirrhotic. The most frequent causes of liver disease were hepatitis C (41.2%), followed by alcohol (13.2%), hepatitis C/alcohol (11.7%) and non-alcoholic fatty liver disease (5.8%). Decompensated cirrhosis (46.7%) was the main reason for hospital admission. The most often prescribed PHD were antibiotics (67.7%), cardiovascular drugs (34.4%), neuromodulators (26.1%) and anesthetics (19.9%). After exposure, 113 patients (38.8%) presented significant elevated liver enzymes. Surprisingly, PHD were more often prescribed in GI/Liver unit (48.8%) followed by emergency/intensive care unit (28.5%). A total of 65 patients (22%) died, however in neither case was it possible to safely infer causal relationship among PHD, liver enzymes and death. Conclusion: PHD prescription is frequent in patients with CLD even in a tertiary university hospital and in the gastroenterology and hepatology department, exposing these patients to an additional risk. Rodrigo DoreloSamantha T.A. BarcelosMagela BarrosValeria ElustondoYsela Y.P. PérezMartin OricchioNelson D.S. UribeNelia HernandezDvora JovelevithsMario R. Alvares-da-SilvaUniversidad Nacional Hermilio Valdizánarticleliver diseasesdrug-induced liver injuryacute-on-chronic liver failureacute liver failureMedicine (General)R5-920Public aspects of medicineRA1-1270ESRevista Peruana de Investigación en Salud, Vol 5, Iss 4 (2021)
institution	DOAJ
collection	DOAJ
language	ES
topic	liver diseases drug-induced liver injury acute-on-chronic liver failure acute liver failure Medicine (General) R5-920 Public aspects of medicine RA1-1270
spellingShingle	liver diseases drug-induced liver injury acute-on-chronic liver failure acute liver failure Medicine (General) R5-920 Public aspects of medicine RA1-1270 Rodrigo Dorelo Samantha T.A. Barcelos Magela Barros Valeria Elustondo Ysela Y.P. Pérez Martin Oricchio Nelson D.S. Uribe Nelia Hernandez Dvora Joveleviths Mario R. Alvares-da-Silva Potentially hepatotoxic drugs are still being prescribed to liver disease patients under tertiary care: it is time to say enough
description	Introduction and aim: Drug-induced liver injury (DILI) manifests as a spectrum of clinical presentations that carries morbidity and mortality. Patients with chronic liver disease (CLD), particularly hospitalized, are at high risk for developing DILI. We aimed to investigate the use of potentially hepatotoxic drugs (PHD) in patients with CLD in a tertiary university hospital. Materials and methods: Adult (≥ 18 years-old) with CLD admitted to the hospital from January 2016 to December 2018 were evaluated regarding PHD, assessing the risk of DILI and liver enzymes behavior after exposure. Results: From 931 hospitalized patients with CLD, 291 (31.3%) were exposed to hepatotoxic drugs during their hospitalization. Of those, 244 (83.8%) were cirrhotic. The most frequent causes of liver disease were hepatitis C (41.2%), followed by alcohol (13.2%), hepatitis C/alcohol (11.7%) and non-alcoholic fatty liver disease (5.8%). Decompensated cirrhosis (46.7%) was the main reason for hospital admission. The most often prescribed PHD were antibiotics (67.7%), cardiovascular drugs (34.4%), neuromodulators (26.1%) and anesthetics (19.9%). After exposure, 113 patients (38.8%) presented significant elevated liver enzymes. Surprisingly, PHD were more often prescribed in GI/Liver unit (48.8%) followed by emergency/intensive care unit (28.5%). A total of 65 patients (22%) died, however in neither case was it possible to safely infer causal relationship among PHD, liver enzymes and death. Conclusion: PHD prescription is frequent in patients with CLD even in a tertiary university hospital and in the gastroenterology and hepatology department, exposing these patients to an additional risk.
format	article
author	Rodrigo Dorelo Samantha T.A. Barcelos Magela Barros Valeria Elustondo Ysela Y.P. Pérez Martin Oricchio Nelson D.S. Uribe Nelia Hernandez Dvora Joveleviths Mario R. Alvares-da-Silva
author_facet	Rodrigo Dorelo Samantha T.A. Barcelos Magela Barros Valeria Elustondo Ysela Y.P. Pérez Martin Oricchio Nelson D.S. Uribe Nelia Hernandez Dvora Joveleviths Mario R. Alvares-da-Silva
author_sort	Rodrigo Dorelo
title	Potentially hepatotoxic drugs are still being prescribed to liver disease patients under tertiary care: it is time to say enough
title_short	Potentially hepatotoxic drugs are still being prescribed to liver disease patients under tertiary care: it is time to say enough
title_full	Potentially hepatotoxic drugs are still being prescribed to liver disease patients under tertiary care: it is time to say enough
title_fullStr	Potentially hepatotoxic drugs are still being prescribed to liver disease patients under tertiary care: it is time to say enough
title_full_unstemmed	Potentially hepatotoxic drugs are still being prescribed to liver disease patients under tertiary care: it is time to say enough
title_sort	potentially hepatotoxic drugs are still being prescribed to liver disease patients under tertiary care: it is time to say enough
publisher	Universidad Nacional Hermilio Valdizán
publishDate	2021
url	https://doaj.org/article/fb1f743af31b4897baa9eeffeb7230e6
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Potentially hepatotoxic drugs are still being prescribed to liver disease patients under tertiary care: it is time to say enough

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