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Characteristics of Drug-induced Liver Injury in Chronic Liver Disease:Results from the Thai Association for the Study of the Liver(THASL)DILI Registry

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Journal of Clinical and Translational Hepatology 2023年第1期11卷 88-96页

作者： Sakkarin Chirapongsathorn Wattana Sukeepaisarnjaroen Sombat Treeprasertsuk Roonguedee Chaiteerakij Pichaporn Surawongsin Chanunta Hongthanakorn Sith Siramolpiwat naichaya chamroonkul Chalermrat Bunchorntavakul Watcharasak Chotiyaputta Kittiyod Poovorawan Rattana Boonsirichan Saranath Lawpoolsri Chinnavat Sutivana Abhasnee Sobhonslidsuk Division of Gastroenterology and Hepatology Department of MedicinePhramongkutklao Hospital and College of MedicineRoyal Thai ArmyBangkokThailand Division of Gastroenterology and Hepatology Faculty of MedicineKhon Kaen UniversityKhon KaenThailand Division of Gastroenterology Faculty of MedicineChulalongkorn UniversityBangkokThailand Division of Gastroenterology Bhumibol Adulyadej HospitalBangkokThailand Division of Gastroenterology Faculty of MedicineThammasat UniversityPratumthaniThailand Division of Gastroenterology and Hepatology Faculty of MedicinePrince of Songkla UniversitySongklaThailand Division of Gastroenterology and Hepatology Rajavithi HospitalCollege of MedicineRangsit UniversityBangkokThailand Division of Gastroenterology Faculty of MedicineSiriraj HospitalMahidol UniversityBangkokThailand Department of Clinical Tropical Medicine Faculty of Tropical MedicineMahidol UniversityBangkokThailand Division of Gastroenterology Faculty of MedicineVajira HospitalBangkokThailand Center of Excellence for Biomedical and Public Health Informatics(BIOPHICS) Faculty of Tropical MedicineMahidol UniversityBangkokThailand Division of Gastroenterology and Hepatology Faculty of MedicineRamathibodi HospitalMahidol UniversityBangkokThailand

Background and Aims:The impact of drug-induced liver injury(DILI)on patients with chronic liver disease(CLD)is unclear.There are few reports comparing DILI in CLD and non-CLD patients.In this study,we aimed to determine the incidence and outcomes of DILI in patients with and without CLD.Methods:We collected data on eligible individuals with suspected DILI between 2018 and 2020 who were evaluated systematically for other etiologies,causes,and the severity of DILI.We compared the causative agents,clinical features,and outcomes of DILI among subjects with and without CLD who were enrolled in the Thai Association for the Study of the Liver DILI registry.Subjects with definite,or highly likely DILI were included in the analysis.Results:A total of 200 subjects diagnosed with DILI were found in the registry.Of those,41 had CLD and 159 had no evidence of CLD in their background.Complementary and alternative medicine(CAM)products were identified as the most common class of DILI agents.Approximately 59%of DILI in the CLD and 40%in non-CLD group were associated with CAM use.Individuals with pre-existing CLD had similar severity including mortality.Twelve patients(6%)developed adverse outcomes related to DILI including seven(3.5%)deaths and five(2.5%)with liver failure.Mortality was 4.88%in CLD and 3.14%in non-CLD subjects over median periods of 58(8–106)days and 22(1–65)days,respectively.Conclusions:In this liver disease registry,the causes,clinical presentation,and outcomes of DILI in subjects with CLD and without CLD patients were not different.Further study is required to confirm our findings.

关键词： Chronic liver disease Cirrhosis Drug-induced liver injury Druginduced liver injury network Toxicity Medication

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Bacterial infections in cirrhosis: A critical review and practical guidance

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World Journal of Hepatology 2016年第6期8卷 307-321页

作者： Chalermrat Bunchorntavakul naichaya chamroonkul Disaya Chavalitdhamrong Division of Gastroenterology and Hepatology Department of Internal Medicine Rajavithi Hospital College of Medicine Rangsit University Division of Gastroenterology and Hepa-tology Department of Internal Medicine Faculty of Medicine Prince of Songkla University Division of Gastroenterology Department of Internal Medicine Harbor--UCLA Medical

Bacterial infection is common and accounts for major morbidity and mortality in cirrhosis. Patients with cirrhosis are immunocompromised and increased susceptibility to develop spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. Once infection develops, the excessive response of pro-inflammatory cytokines on a pre-existing hemodynamic dysfunction in cirrhosis further predispose the development of serious complications such as shock, acute-on-chronic liver failure, renal failure, and death. Spontaneous bacterial peritonitis and bacteremia are common in patients with advanced cirrhosis, and are important prognostic landmarks in the natural history of cirrhosis. Notably, the incidence of infections from resistant bacteria has increased significantly in healthcare-associated settings. Serum biomarkers such as procalcitonin may help to improve the diagnosis of bacterial infection. Preventive measures(e.g., avoidance, antibiotic prophylaxis, and vaccination), early recognition, and proper management are required in order to minimize morbidity and mortality of infections in cirrhosis.

关键词： Bacteria Infection Sepsis Bacteremia Liver cirrhosis Vaccination Spontaneous peritonitis Immune dysfunction

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