Published online Feb 27, 2025. doi: 10.4254/wjh.v17.i2.101741
Revised: November 28, 2024
Accepted: December 25, 2024
Published online: February 27, 2025
Processing time: 148 Days and 1.3 Hours
Acute drug-induced liver injury (DILI) events caused by chronic liver disease are relatively common. Some researchers believe that nonalcoholic fatty liver (NAFL) increases the overall risk of DILI. The clinical characteristics and prognosis of DILI in the context of NAFL disease (NAFLD) are still unclear. Therefore, hospitalized patients with NAFLD combined with DILI at the Tianjin Second People's Hospital were included in this study. The clinical manifestations, classifications, severities, laboratory indicators, and clinical outcomes of the enrolled patients were analyzed, and the clinical characteristics and prognoses of the NAFL + DILI patients were evaluated.
To investigate the clinical characteristics and prognosis of DILI in the context of NAFL.
Eighty-nine patients diagnosed with DILI and 110 patients diagnosed with both DILI and NAFL at the Tianjin Second People's Hospital were enrolled. Clinical data, including demographic characteristics, clinical features, laboratory test results, pathology findings, autoantibody titers, suspected drugs, and outcomes, were collected from the two groups of patients. All enrolled patients were followed up to determine the liver function recovery time.
Compared with the patients in the DILI group, those in the NAFL + DILI group had higher body mass indices; Controlled Attenuation Parameter scores; and triglyceride, total cholesterol, low-density lipoprotein, and insulin levels. The levels of the cytokines interleukin-4 and complement complement c3 (C3) were also greater in the NAFL + DILI group than in the DILI group. The proportions of patients with cholestatic-type DILI (16.4% vs 4.5%), cholestasis seen on pathoscopy (40.9% vs 25.8%), grade 2 or above DILI (48.18% vs 40.45%), and a recovery time for liver function ranging from 90 to 180 days (30.6% vs 15.5%) were greater in the NAFL + DILI group than in the DILI group. All of the abovementioned differences between the groups were statistically significant (P < 0.05). The autoantibody positivity rates did not significantly differ between the two groups (P > 0.05), and the proportions of patients who progressed to chronic drug hepatitis or autoimmune hepatitis were not significantly different between the two groups (both P > 0.05).
In the context of NAFL, DILI is more likely to be cholestatic, with a greater degree of liver injury, a longer recovery time, and more pronounced expression of immune factors.
Core Tip: In this retrospective study, we explored the clinical features and prognosis of patients with drug-induced liver injury (DILI) in the setting of nonalcoholic fatty liver (NAFL). We recruited a total of 199 patients diagnosed with DILI by clinical and biochemical indicators. The number of patients diagnosed with NAFL by pathologic biopsy, ultrasound, and computed tomography was 110, and the number of patients without NAFL was 89. DILI resulting from NAFL had more pronounced metabolic index abnormalities, was more prone to cholestasis, had a greater degree of hepatic injury, had a longer recovery time, and may involve more pronounced immunologic factors.