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|Title:||Drug-induced Liver Injury is Frequently Associated with Severe Cutaneous Adverse Drug Reactions: Experience from Two Australian Tertiary Hospitals.|
|Authors:||Fang, Wendy C;Adler, Nikki R;Graudins, Linda V;Goldblatt, Caitlin;Goh, Michelle Sy;Roberts, Stuart K;Trubiano, Jason A;Aung, Ar Kar|
|Affiliation:||Alfred Health, Melbourne, Victoria, Australia|
Victorian Melanoma Service, Alfred Hospital, Melbourne
School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
Austin Health, Heidelberg, Victoria, Australia..
Monash University, Melbourne, Victoria, Australia
|Citation:||Internal medicine journal 2018; online first: 8 January|
|Abstract:||Drug-induced liver injury can be associated with certain cutaneous adverse drug reactions. We aim to demonstrate the prevalence of drug-induced liver injury in patients with cutaneous adverse drug reactions. Severity and patterns of liver injury, risk factors, causal medications and outcomes are also examined. A retrospective cohort study of patients with cutaneous adverse drug reactions was conducted across two hospitals in Australia. Patients were identified through cross-linkage of multiple databases. 104 patients with cutaneous adverse drug reactions were identified. Of these, 33 (31.7%) had liver injury, representing 50% of patients with drug reaction with eosinophilia and systemic symptoms, and 30.2% of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis. Most cases of liver injury (69.7%) were of a cholestatic/mixed pattern with severe disease in 18.2%. No significant risk factors for development of liver injury were noted, but peripheral lymphocytosis may represent a risk in patients with Stevens-Johnson syndrome (OR=6.0, 95% CI:1.8-19.7, p=0.003). Antimicrobials were the most common class to be implicated in drug-induced liver injury. The median length of inpatient stay was longer in patients with liver injury compared to those without (19 vs. 11 days, p=0.002). The mortality rate in those with liver injury was 15.2% and 9.9% in those without. No patients required liver transplantation. Drug-induced liver injury commonly occurs in patients with cutaneous adverse drug reactions and is associated with longer inpatient stay. Patients with Stevens-Johnson/toxic epidermal necrolysis and peripheral lymphocytosis appear to be at higher risk for developing associated liver injury.|
|Subjects:||Stevens Johnson syndrome|
adverse drug reaction
drug hypersensitivity syndrome
drug induced liver injury
drug reaction with eosinophilia and systemic symptoms
|Appears in Collections:||Journal articles|
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