Model for end-stage liver disease score as a predictor of short-term outcome in patients with drug-induced liver injury

Abstract

Objectives. The purposes of this study were to investigate the clinical presentation, cause and outcome of drug-induced liver injury (DILI) and to evaluate the predictive value of the model for end-stage liver disease (MELD) score in DILI. Methods. Patients diagnosed with DILI between January 1, 2010 and December 31, 2012 in the Emergency Department at Asan Medical Center in Seoul, Korea were analyzed retrospectively. The primary end point was poor outcome, defined as liver transplantation or death within 30 days of the initial hospital visit. Results. Of 213 patients, 13.1% had a 30-day poor outcome. Folk remedies were the most common cause of DILI in 147 patients (69%). Univariate logistic regression analysis showed that multiple drugs (odds ratio [OR] 2.30, 95% confidence interval [CI]: 1.03–5.15), concurrent alcohol consumption (OR 3.69, 95% CI: 1.03–13.18), white blood cell (WBC) count (OR 1.17, 95% CI: 1.07–1.28), hemoglobin (Hb) (OR 0.60, 95% CI: 0.49–0.74), platelet count (OR 0.993, 95% CI: 0.987–0.998), total bilirubin (OR 1.09, 95% CI: 1.06–1.13) and MELD (OR 1.23, 95% CI: 1.15–1.32) were significantly associated with 30-day poor outcomes. Multivariate analysis showed that the MELD (OR 1.21, 95% CI: 1.12–1.30) and Hb (OR 0.77, 95% CI: 0.61–0.98) were independent predictors of poor outcome. For 30-day mortality, the c-statistics for MELD alone and for combination of MELD and Hb were 0.93 (95% CI: 0.89–0.97) and 0.94 (95% CI: 0.90–0.97), respectively. Conclusion. The outcome of patients with DILI was poor. MELD score and Hb were reliable predictors of short-term outcome in patients with DILI.

Key Words:

• drug-induced liver injury
• liver transplantation
• MELD score
• mortality
• prognosis

Acknowledgement

This study was supported by a grant from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea (grant No.: 2013-0348).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.