Gut Liver.  2015 Jul;9(4):525-533. 10.5009/gnl14184.

Causes, Features, and Outcomes of Drug-Induced Liver Injury in 69 Children from China

• Zhu Y
• Li YG
• Wang JB
• Liu SH
• Wang LF
• Zhao YL
• Bai YF
• Wang ZX
• Li JY
• Xiao XH

• KMID: 2160637
• DOI: http://doi.org/10.5009/gnl14184

Abstract

BACKGROUND/AIMS
Drug-induced liver injury (DILI) is a frequent cause of pediatric liver disease; however, the data on DILI are remarkably limited.
METHODS
All 69 children hospitalized with DILI between January 2009 and December 2011 were retrospectively studied.
RESULTS
A total of 37.7% of the children had medical histories of respiratory infection. The clinical injury patterns were as follows: hepatocellular 89.9%, cholestatic 2.9%, and mixed 7.2%. Liver biopsies from 55 children most frequently demonstrated chronic (47.3%) and acute (27.3%) hepatitis. Hypersensitivity features, namely, fever (31.9%), rash (21.7%), and eosinophilia (1.4%), were found. Twenty-four children (34.8%) developed chronic DILI. Antibiotics (26.1%) were the most common Western medicines (WMs) causing DILI, and the major implicated herbs were Ephedra sinica and Polygonum multiflorum. Compared with WM, the children whose injuries were caused by Chinese herbal medicine (CHM) showed a higher level of total bilirubin (1.4 mg/dL vs 16.6 mg/dL, p=0.004) and a longer prothrombin time (11.8 seconds vs 17.3 seconds, p=0.012), but they exhibited less chronic DILI (2/15 vs 18/39, p=0.031).
CONCLUSIONS
Most cases of DILI in children are caused by antibiotics or CHM used to treat respiratory infection and present with hepatocellular injury. Compared with WM, CHM is more likely to cause severe liver injury, but liver injury caused by CHM is curable.

Keyword

Pediatric; Hepatotoxicity; Diagnosis; Chinese herbal medicine; Liver biopsy

MeSH Terms

Anti-Bacterial Agents/*adverse effects
Bilirubin/blood
Child
Child, Preschool
China
Drug-Induced Liver Injury/blood/*etiology/pathology
Drugs, Chinese Herbal/*adverse effects
Female
Humans
Liver/pathology
Male
Prothrombin Time
Respiratory Tract Infections/*complications/drug therapy
Retrospective Studies
Anti-Bacterial Agents
Bilirubin
Drugs, Chinese Herbal