S1011 Etiology and Outcomes of Drug-Induced Liver Injury in a Multi-Ethnic United States Population

INTRODUCTION: Drug Induced Liver Injury (DILI) is a leading cause of acute liver failure in the United States. We reviewed DILI rates and clinical outcomes of a multi-ethnic cohort of patients from Miami that were reported to the Florida Poison Information Center (FPIC). METHODS: Cases of suspected DILI from 2007 to 2019 were extracted from the FPIC database. Retrospective electronic chart review was conducted on cases referred to Jackson Memorial Hospital and the University of Miami Hospital, which includes a large Miami-based academic transplant center. Herein, we submit our report on medications implicated in DILI and clinical outcomes in this cohort. RESULTS: Ninety confirmed cases of DILI were identified, comprising a majority of males (55.6%) aged < 50 years (78.9%), and were Hispanic (42.2%), White (28.9%) and Black (28.9%). Acetaminophen was the most common drug implicated (61.1%) followed by drugs of abuse (22.2%). Hepatocellular pattern of injury based on peak R-factor was noted in 88.9% of cases, mixed in 7.8%, and cholestatic in 3.3%. As per the DILIN severity grading scale, 78.9% were classified as Grade 4, 11.1% as Grade 3, 8.9% as Grade 2 and 1.1% as Grade 1 (Table 1). Peak transaminase elevation of >10,000 IU/ml was observed in 12.2% of cases and >1,000 IU/ml in 65.6%. Alkaline phosphatase levels were < 3X ULN in 95.6% of cases. Additionally, 92.2% had peak total bilirubin levels of < 10 mg/dL, 4.4% between 10-20 mg/dL, and 3.3% > 20 mg/dL. A majority of patients (56.7%) required ICU admission. Average hospital length of stay (LOS) was 10.3 days. Overall mortality was 16.7% (15 cases); see Table 2 for a detailed breakdown. None of the patients who were tested for Hepatitis E were positive, one patient underwent liver biopsy, and one patient underwent transplantation. Cases that met Hy’s law (33, 36.7%), when compared to those that did not, had higher rates of ICU admission (78.8% vs. 43.9%), longer LOS (12.2 days vs. 9.0 days) and increased mortality (39.4% vs. 3.5%) (Figure 1). CONCLUSION: In this multi-ethnic cohort from two large academic centers in Miami, including a major transplant center, hepatocellular pattern of injury was the most frequent type of DILI. Overall mortality was 16.7%, and high initial MELD score was observed in most cases. Cases that met Hy’s Law had higher rates of ICU admission, longer LOS, and increased mortality. The rate of liver transplantation was low as patients who could have benefited were too sick or had contraindications.Table 1.: Demographics, Etiology, and Severity Characteristics of the CohortTable 2.: Laboratory and Hospitalization Characteristics of Expired PatientsFigure 1.: Comparing ICU Admission and Mortality between cases that met and did not meet Hy's Law.