Clinical characteristics of drug-induced liver injury and primary biliary cirrhosis

doi:10.3748/wjg.v22.i33.7579

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World Journal of Gastroenterology

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1007-9327

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Retrospective Study

World J Gastroenterol. Sep 7, 2016; 22(33): 7579-7586
Published online Sep 7, 2016. doi: 10.3748/wjg.v22.i33.7579

Table 1 Comparison of biochemical indexes between drug-induced liver injury and primary biliary cirrhosis patients

	TP (g/L)	ALB (g/L)	AST (U/L)	ALT (U/L)	ALP (U/L)	GGT (U/L)	TBIL (μmol/L)	DBIL (μmol/L)	IBIL (μmol/L)
DILI (n = 124)	66.2 ± 7.2	38.8 ± 5.6	391.0 (148.0-731.0)	503.0 (263-904)	179.0 (121.0-294.0)	200 (108.0-373.0)	31.5 (14.88-109.2)	49.3 (15.9-139.6)	16.0 (10.6-37.2)
PBC (n = 116)	74.9 ± 9.4	37.6 ± 5.9	113.5 (74.8-190.5)	113.0 (69.0-193.3)	264.0 (166.3-443.3)	311.5 (148.0-660.3)	78.6 (25.2-189.0)	16.3 (5.78-60.6)	10.9 (7.38-21.6)

DILI: Drug-induced liver injury; PBC: Primary biliary cirrhosis; TP: Total protein; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TBIL: Total bilirubin; GGT: Gamma glutamyl transferase; DBIL: Direct bilirubin; IBIL: Indirect bilirubin.

Table 2 Comparison of immunoglobulins between untyped drug-induced liver injury and primary biliary cirrhosis patients

	IgG (g/L)	IgM (g/L)	IgA (g/L)
DILI (n = 124)	13.1 ± 3.7	1.4 ± 0.8	2.6 ± 1.2
PBC (n = 116)	18.8 ± 7.7	4.4 ± 2.9	3.4 ± 1.5

DILI: Drug-induced liver injury; PBC: Primary biliary cirrhosis.

Table 3 Comparison of autoantibodies between untyped drug-induced liver injury and primary biliary cirrhosis patients n (%)

	ANA	AMA	SMA	AMA-M2	AMA-M4	AMA-M9
DILI (n = 124)	55 (44.3)	4 (3.22)	4 (3.22)	3 (2.42)	1 (0.80)	3 (2.42)
PBC (n = 116)	98 (84.4)	98 (84.4)	2 (3.45)	98 (84.4)	34 (29.3)	19 (16.3)
χ²	41.761	161.932	0.554	165.598	39.091	14.027
P value	< 0.0001	< 0.0001	0.685	< 0.0001	< 0.0001	< 0.0001

DILI: Drug-induced liver injury; PBC: Primary biliary cirrhosis; ANA: Antinuclear antibody; AMA: Antimitochondrial antibody; SMA: Anti-smooth muscle antibody.

Table 4 Comparison of antinuclear antibody at different titers between untyped drug-induced liver injury and primary biliary cirrhosis patients n (%)

	1:100	1:320	1:1000	1:3200	1:10000
DILI (n = 124)	43 (34.6)	9 (7.25)	2 (1.61)	1 (0.80)	0
PBC (n = 116)	20 (17.2)	27 (23.2)	30 (25.8)	19 (16.3)	2 (1.72)
χ²	9.412	12.060	30.498	19.027	2.156
P value	0.0002	0.001	< 0.0001	< 0.0001	0.233

DILI: Drug-induced liver injury; PBC: Primary biliary cirrhosis.

Table 5 Comparison of biochemical indexes between typed drug-induced liver injury and primary biliary cirrhosis patients (median)

	TP (g/L)	ALB (g/L)	AST (U/L)	ALT (U/L)	ALP (U/L)	GGT (U/L)	TBIL (μmol/L)	DBIL (μmol/L)	IBIL (μmol/L)
Hepatocellular type DILI (n = 90)	66.8 ± 8.0^a	39.2 ± 6.2	442.5 (174.3-941.5)^a	574.0 (205.6-1263.3)^a^c^e	145.5 (86.3-217.5)^a^c^e	179.0 (87.0-366.1)^a	74.30 (32.4-160.7)	46.2 (17.8-96.6)	16.2 (11.4-19.5)
Cholestatic type DILI (n = 20)	63.7 ± 7.2^a	39.1 ± 5.8	135.0 (82.6-185.8)	154.0 (49.2-253.8)	320.6 (196.6-454.2)	208.50 (110.5-426.8)	126.90 (55.3-266.7)	99.0 (38.8-214.3)	26.2 (13.3-35.2)
Mixed type DILI (n = 14)	70.8 ± 8.6	37.6 ± 4.4	654.1 (317.2-1389.1)^a^c	844.0 (551.8-1945.8)^a^c	328.75 (258.4-477.2)	260.50 (142.8-418.5)	111.10 (41.3-234.9)^a	95.2 (56.7-266.8)^a	21.9 (14.6-33.2)^a
PBC (n = 116)	74.9 ± 9.4	37.6 ± 6.0	113.5 (74.8-190.5)	113.0(69.0-193.3)	264.0 (166.3-443.3)	311.5 (148.0-660.3)	78.6 (25.2-189.0)	16.3 (5.8-60.6)	10.9 (7.4-21.6)

^aP < 0.05 vs the PBC group;

^cP < 0.05 vs the cholestatic type DILI group;

^eP < 0.05 vs the mixed type DILI group. DILI: Drug-induced liver injury; PBC: Primary biliary cirrhosis; TP: Total protein; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TBIL: Total bilirubin; GGT: Gamma glutamyl transferase; DBIL: Direct bilirubin; IBIL: Indirect bilirubin; ALP: Alkaline phosphatase.

Table 6 Comparison of immunoglobulins between typed drug-induced liver injury and primary biliary cirrhosis patients (median)

	IgG (g/L)	IgM (g/L)	IgA (g/L)
Hepatocellular type DILI (n = 90)	12.6 ± 5.2^a	1.1 ± 0.5^a	2.3 ± 1.0^a
Cholestatic type DILI (n = 20)	13.2 ± 5.7^a	1.3 ± 0.6^a	2.3 ± 1.2
Mixed type DILI (n = 14)	11.9 ± 4.7^a	1.1 ± 0.6^a	2.1 ± 1.4
PBC (n = 116)	18.8 ± 7.7	4.4 ± 2.9	3.4 ± 1.5

^aP < 0.05 vs the PBC group. DILI: Drug-induced liver injury; PBC: Primary biliary cirrhosis.

Table 7 Comparison of autoantibodies between typed drug-induced liver injury and primary biliary cirrhosis patients n (%)

	Autoantibodies	ANA	AMA	SMA	AMA-M2	AMA-M4	AMA-M9
Hepatocellular type DILI (n = 90)	43 (47.7)^a	41 (45.5)^a	2 (2.22)^a	2 (2.22)	2 (2.22)^a	0^a	1 (1.11)^a
Cholestatic type DILI (n = 20)	10 (50.0)^a	8 (40.0)^a	2 (10.0)^a	1 (5.00)	1 (5.00)^a	0^a	1 (5.00)
Mixed type DILI (n = 14)	6 (42.8)^a	6 (42.8)^a	0^a	1 (7.14)	0^a	1 (7.14)	1 (7.14)
PBC (n = 116)	106 (91.3)	98 (84.4)	98 (84.4)	2 (1.72)	98 (84.4)	34 (29.3)	19 (16.3)

^aP < 0.05 vs the PBC group. DILI: Drug-induced liver injury; PBC: Primary biliary cirrhosis; ANA: Antinuclear antibody; AMA: Antimitochondrial antibody; SMA: Anti-smooth muscle antibody.

Table 8 Comparison of ANA at different titers between typed drug-induced liver injury and primary biliary cirrhosis patients n (%)

	1:100	1:320	1:1000	1:3200	1:10000
Hepatocellular type DILI (n = 90)	34 (37.7)^a	7 (7.77)^a	1 (1.11)^a	0^a	0
Cholestatic type DILI (n = 20)	5 (25.0)	2 (10.0)^a	0^a	1 (5.00)	0
Mixed type DILI (n = 14)	4 (28.5)	1 (7.14)	1 (7.14)	0 (0.00)	0
PBC (n = 116)	20 (17.2)	27 (23.2)	30 (25.8)	19 (16.3)	2 (1.72)

^aP < 0.05 vs the PBC group. Since the number of cases with ANA at a titer of 1:10000 was 0 in the hepatocellular type DILI, cholestatic type DILI, and mixed type DILI groups, comparisons between them cannot be done. DILI: Drug-induced liver injury; PBC: Primary biliary cirrhosis.

Citation: Yang J, Yu YL, Jin Y, Zhang Y, Zheng CQ. Clinical characteristics of drug-induced liver injury and primary biliary cirrhosis. World J Gastroenterol 2016; 22(33): 7579-7586
URL: https://www.wjgnet.com/1007-9327/full/v22/i33/7579.htm
DOI: https://dx.doi.org/10.3748/wjg.v22.i33.7579