Profile of adult patients admitted with drug-induced liver injury at a district hospital in Pietermaritzburg, KwaZulu-Natal

Figures & data

Figure 1: Burden of DILI at NDH according to the chart review of in-patient records over the two-year period.

Table 1: Patient and laboratory characteristics at baseline of those who developed drug-induced liver injury (n = 95)

Variable	Mean ± SD (%)	Minimum	Maximum	95% CI
Age (years)	38.04 ± 13.58	19	85	35.27–40.81
Median	35
Age groups:
18–24	9 (9.5)
25–29	23 (24.2)
30–34	14 (14.7)
35–39	17 (17.9)
40–49	16 (16.8)
50–59	6 (6.3)
≥ 60	10 (10.5)
Ethnicity:
Black	78 (82.1)
Indian	11 (11.6)
Coloured	4 (4.2)
White	2 (2.1)
Gender:
Male	36 (37.9)
Female	59 (62.1)
Marital status:
Married	23 (24.2)
Single	24 (25.3)
In a relationship	45 (47.4)
Divorced	1 (1.1)
Not documented	2 (2.1)
Professional status:
Employed	22 (24)
Unemployed	73 (76)
Weight (kg)	56.69 ± 9.05	31	87	54.85–58.54
Median	56
Hospital stay (days)	8.35 ± 4.4	1	29	7.44–9.25
Median	7
HIV status:
Positive	72 (75.8)
Negative	23 (24.2)
CD4 count (cells/mm^3)	288.42 ± 296.29	2	479	218.79–358.04
Median:	180
< 500	56 (77.8)
> 500	16 (22.2)
Antiretroviral therapy:
Yes	62 (86.1)
No	10 (13.9)
Type of ART:
FDC	55 (89)
Second line	7 (11)
TB:
Positive	41 (43)
Negative	54 (57)
TB therapy:
Yes	40 (98)
No	1(2)
Hepatitis screen:
Negative	81 (86)
HAV (Hep A IgM positive*)	1 (1)
HBV (Hep B SAg positive^#)	12 (13)

*Hepatitis A virus: hepatitis A Immunoglobulin M.

^#Hepatitis B virus: hepatitis B Surface Antigen.

Table 2: Multivariate analysis of risk factors for drug induced liver injury (n = 95)

Factor	OR	95%CI	p-value
Dependent variables:
ALT	2.2	1.5–4.6	0.01
Independent variables:
Female gender	1.8	1.2–2.5	0.02
Low albumin	3.4	1.8–6.1	0.001
Alcohol	2.1	1.8–4.9	0.002
Age > 24 years	2.6	2.1–6.6	0.01

Table 3: Subgroup analysis of patients with drug-induced liver injury

Subgroup	Number	Percentage
HIV/TB naive	18	18.9
HIV	37	38.9
TB	5	5.3
HIV and TB	35	36.8

Table 4: Characteristics of patients in the four subgroups

Variable	All (n = 95)	TB and HIV naive (n = 18)	HIV (n = 37)	TB (n = 5)	HIV and TB (n = 35)
Age (years)	38.04 ± 13.58	43.22 ± 18.42	35.86 ± 10.59	44.20 ± 18.54	36.80 ± 12.45
Gender:
Male	36	12	10	3	11
Female	59	6	27	2	24
ALT (IU/l)	540.94 ± 380.57	494.22 ± 394.55	521.54 ± 313.01	431.00 ± 267.53	601.17 ± 450.93
Bilirubin (μmol/l)	148.28 ± 119.58	173.28 ± 176.93	165.24 ± 120.97	62.00 ± 32.50	129.83 ± 79.97
Albumin (g/l)	21.06 ± 14.05	30.00 ± 28.07	19.64 ± 5.85	27.00 ± 5.09	17.09 ± 6.48
INR	2.20 ± 1.20	1.57 ± 0.33	2.14 ± 1.22	1.37 ± 0.18	2.69 ± 1.34
Hospital stay (days)	8.35 ± 4.4	7.2 ± 4.9	7.6 ± 3.6	7.2 ± 1.9	9.9 ± 4.9

Table 5: Co-morbidity

Co-morbidity	Number	Percentage
Renal disease (GFR < 60)	33	34.7
Malnutrition (Alb < 35)	30	31.6
Hypertension	12	12.6
Hypercholesterolaemia	11	11.6
Diabetes	6	6.3

Table 6: Exposure to various hepatotoxic drugs (excluding ART, TBT and Alcohol)

Drug	Number (%)
Paracetamol	44 (46.3)
Cotrimoxazole	31 (32.6)
Traditional medicines	26 (27.4)
Fluconazole	14 (14.7)
Amoxicillin/clavulanic acid	4 (14.7)
Isoniazid	12 (12.6)
Statins	11 (11.6)
Erythromycin/azithromycin	9 (9.5)
Recreational drugs	8 (8.4)
Salicylates	6 (6.3)
Oral hypoglycaemic drugs	5 (5.3)
Oral contraceptive agents	5 (5.3)
Sodium valproate	4 (4.2)
Carbamazepine	2 (2.1)