Annals of Hepatology (Sep 2021)

O-28 DRUG-INDUCED LIVER INJURY IN LATINAMERICA: First ten years’ experience of the ongoing LATINDILI Network

  • Fernando Bessone,
  • Nelia Hernandez,
  • Raymundo Parana,
  • Manuel Mendizabal,
  • Adriana Sanchez,
  • Vinicius Nunes,
  • Ezequiel Ridruejo,
  • Daniela Schiodi,
  • Genario Santos,
  • Eduardo Fassio,
  • Schinoni Maria I.,
  • Hugo Tanno,
  • Martin Tagle,
  • Pedro Montes,
  • Marco Arrese,
  • Nahum Mendez-Sanchez,
  • Javier Brahm,
  • Marcos Girala,
  • Isabel Lizarzábal M.,
  • Edgardo Mengual,
  • Enrique Carrera,
  • Fernando Contreras,
  • Inmaculada Medina-Caliz,
  • Mercedes Robles-Díaz,
  • Aida Ortega-Alonso,
  • Miren García-Cortes,
  • Ismael Alvarez-Alvarez,
  • Hao Niu,
  • Elvira Bonilla,
  • Isabel Lucena M.,
  • Andrade Raul J.

Journal volume & issue
Vol. 24
p. 100515

Abstract

Read online

Introduction: In 2011, the Latin-American DILI-Network (LATINDILIN) set up under the guidance of the Spanish DILI Registry a network of hepatologists to prospectively identify and characterize DILI patients. Aim: To evaluate the drugs more frequently associated with DILI in LA, clinical phenotype and outcome. Methods: Demographics, clinical and biochemical parameters of all cases included in the LATINDILI Network were analysed according to the type of liver injury (hepatocellular, Hep; cholestatic, Chol and mixed, Mix). Results: 404 DILI cases were included. Anti-infectives (31%), musculoskeletal system drugs (13%) and herbal products (9.2%) were the main causative therapeutic drug classes. Mean age was 49 years (female sex, 61%). Hep injury predominated (62%) whereas Chol and Mix patterns were 24% and 15% of cases, respectively. Chol patients (mean age 56y) were older than Hep and Mix cases (47 and 50, p<0.05). Jaundice was more prevalent in Chol and Mix injury than in Hep cases (65% vs 75% vs 58%, respectively, p=0.062), though no differences in hospitalization rates were observed (Hep 43%, Chol and Mix 46%, p=0.867). Of note, 12 cases, mostly Hep, had a positive rechallenge. Positive autoantibodies were more common in Hep cases (25% vs Chol 9.1% vs Mix 19%, p=0.010), with nitrofurantoin/herbal products as the most common causative agents. Hep cases showed a higher risk of severe/fatal injury (18% vs 6.0% and 1.8% in Chol and Mix cases, respectively, p<0.001). The new Hy's law performed as expected, with 14% of ALF/Tx cases. Hep cases more frequently died from liver-related death (3.5%) compared with Chol (1.1%) and Mix (0) cases. Conclusions: In Latin-American DILI cases with Hep pattern predominated, showing a higher severity and most frequent inadvertent re-exposition. The LATINDILI Network is proving as an important tool for the characterization of DILI singularities in this world region, and improvement of Public Health. Funding: AEMPS, FEDER (PI18/01804). COST Action CA-17112.