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Drug-induced liver injury in children: A nationwide cohort study from China

Rongtao Lai1, Xinjie Li2, Jie Zhang3

  • 1Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

JHEP Reports : Innovation in Hepatology
|August 6, 2024
PubMed

Insights

Adolescents face a higher risk of severe drug-induced liver injury (DILI) in China. This study highlights the need for increased awareness and vigilance in pediatric DILI management.

Area of Science:

  • Hepatology
  • Pediatric Gastroenterology
  • Clinical Pharmacology

Background:

  • Limited data exists on drug-induced liver injury (DILI) clinical profiles in Chinese children.
  • Pediatric DILI is a serious cause of liver disease with varied presentations.

Purpose of the Study:

  • To assess the clinical characteristics of pediatric DILI in China.
  • To identify suspected drugs and outcomes associated with pediatric DILI.
  • To evaluate age-specific risks for DILI severity.

Main Methods:

  • Nationwide, multicenter, retrospective study of 25,927 suspected DILI cases (2012-2014).
  • Inclusion criteria: Roussel Uclaf causality assessment method score ≥6 or expert diagnosis.
  • 460 cases met EASL biochemical criteria, categorized into toddlers, school-age children, and adolescents.

Main Results:

  • Hepatocellular injury predominated (63%), with 34% meeting Hy's law criteria.
  • Adolescents (12-18 years) constituted 65% of moderate/severe DILI cases.
  • Adolescents had a significantly higher risk of severe liver injury (aOR 4.75, p=0.002).
  • Top drug classes: antineoplastic agents (25.9%), antimicrobials (21.5%), traditional Chinese medicine (13.7%).
  • Adolescent suspected drugs: antitubercular drugs (22%), traditional Chinese medicine (23%).

Conclusions:

  • Adolescents are at a greater risk of severe and potentially fatal liver injury from DILI.
  • Recognizing pediatric DILI risks is crucial for safe medical practices.
  • Further prospective studies are needed to assess outpatient and inpatient DILI hepatotoxicity.
Abstract

Keywords:
AdolescentsAntineoplastic agentChemical and drug induced liver injuryTraditional Chinese medicine

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