The impact of eosinophilia and hepatic necrosis on prognosis in patients with drug-induced liver injury
Article first published online: 6 APR 2007
Alimentary Pharmacology & Therapeutics
Volume 25, Issue 12, pages 1411–1421, June 2007
How to Cite
BJÖRNSSON, E., KALAITZAKIS, E. and OLSSON, R. (2007), The impact of eosinophilia and hepatic necrosis on prognosis in patients with drug-induced liver injury. Alimentary Pharmacology & Therapeutics, 25: 1411–1421. doi: 10.1111/j.1365-2036.2007.03330.x
- Issue published online: 6 APR 2007
- Article first published online: 6 APR 2007
- Publication data Submitted 1 February 2007 First decision 1 March 2007 Resubmitted 11 March 2007 Accepted 29 March 2007
Background Drug-induced liver injury may be immunologically mediated or metabolically induced. Peripheral eosinophilia and liver eosinophilia in suspected drug-induced liver injury generally supports the role of drug aetiology.
Aim To assess the importance of eosinophilia and hepatic necrosis on outcome in patients with suspected drug-induced liver injury.
Methods We performed search of MEDLINE for case reports on drug-induced liver injury associated with: amoxicillin/clavulanic acid, carbamazepine, diclofenac, disulfiram, erythromycin, flucloxacillin, halothane, isoniazid, phenytoin, sulindac and trimethoprim/sulfametoxazol.
Results A total of 570 case reports were retrieved. Mortality/transplantation occurred in 112 (20%). Eosinophilia in peripheral blood was reported in 34% of cases, eosinophilia in liver biopsies in 40%, and hepatic necrosis in 41%. Bilirubin levels were lower in patients with peripheral eosinophilia [5.5 × upper limit of normal (interquartile range 2.9–10) vs. 7.7 (4–17); P = 0.02] and patients with liver eosinophilia [5 × upper limit of normal (2.7–10) vs. 10 (5.4–20); P = 0.003] as compared with those without eosinophilia. Eosinophilia in peripheral blood and eosinophilia in liver biopsies were more common in patients who recovered (37% vs. 15.6%; P = 0.0001 and 48% vs. 18.8%; P < 0.0001, respectively). Hepatic necrosis was present in 24% in the survivors vs. 84% in non-survivors (P < 0.0001).
Conclusions In drug-induced liver injury, a favourable outcome was related to the occurrence of eosinophilia, whereas hepatic necrosis was associated with a poor prognosis.