The impact of eosinophilia and hepatic necrosis on prognosis in patients with drug-induced liver injury

Aliment Pharmacol Ther. 2007 Jun 15;25(12):1411-21. doi: 10.1111/j.1365-2036.2007.03330.x.

Abstract

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 x upper limit of normal (interquartile range 2.9-10) vs. 7.7 (4-17); P = 0.02] and patients with liver eosinophilia [5 x 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.

MeSH terms

  • Adult
  • Chemical and Drug Induced Liver Injury*
  • Drug-Related Side Effects and Adverse Reactions / complications*
  • Eosinophilia / chemically induced*
  • Female
  • Humans
  • Liver Diseases / mortality
  • Liver Diseases / pathology
  • Male
  • Middle Aged
  • Necrosis / chemically induced*
  • Prognosis