Drug induced liver injury epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rachita Navara, M.D. [2]

Overview

Epidemiologic data on drug induced liver injury is likely an underrepresentation given the lack of active reporting and surveillance systems for drug induced liver injury worldwide.[1]

Epidemiology and Demographics

Prevalence

The prevalence of drug induced liver injury is estimated to be 44,000 cases annually. It is the most common cause of acute liver failure in the United States, representing 13% of total cases. However, drug induced liver injury accounts for only a small proportion of all idiosyncratic adverse drug reactions.[1]

Incidence

The incidence of drug induced liver injury is approximately 10 to 20 per 100,000 individuals worldwide.[2]

Case Fatality Rate

The case fatality rate of drug induced liver injury is approximately 10 to 50%, depending on the inciting drug. In the United States, the mortality rate is between 9-12%.

Age

It was previously thought that the incidence of drug induced liver injury increases with age. However, more recent studies have demonstrated that patients of all age groups may develop drug induced liver injury.[1]

Gender

Due to the higher proportion of females in many retrospective and prospective cohorts of drug induced liver injury, it was thought that females are more commonly affected than males.[3] However, more recent reviews have demonstrated that drug induced liver injury affects men and women equally.[4]

Race

There is no racial predilection to drug induced liver injury.

Developed Countries

In the Western world, the most common cause of drug induced liver injury is acetaminophen. The next leading cause is antimicrobials, particularly penicillin derivatives in Europe.[5]

Developing Countries

The most common class of drugs implicated in drug induced liver injury worldwide is antimicrobials, particularly antituberculosis medications in India.[5]

References

  1. 1.0 1.1 1.2 Bell LN, Chalasani N (2009). "Epidemiology of idiosyncratic drug-induced liver injury". Semin Liver Dis. 29 (4): 337–47. doi:10.1055/s-0029-1240002. PMC 2903197. PMID 19826967.
  2. Leise MD, Poterucha JJ, Talwalkar JA (2014). "Drug-induced liver injury". Mayo Clin Proc. 89 (1): 95–106. doi:10.1016/j.mayocp.2013.09.016. PMID 24388027.
  3. Hartleb M, Biernat L, Kochel A (2002). "Drug-induced liver damage -- a three-year study of patients from one gastroenterological department". Med Sci Monit. 8 (4): CR292–6. PMID 11951073.
  4. Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J; et al. (2008). "Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States". Gastroenterology. 135 (6): 1924–34, 1934.e1–4. doi:10.1053/j.gastro.2008.09.011. PMC 3654244. PMID 18955056.
  5. 5.0 5.1 Devarbhavi H (2012). "An Update on Drug-induced Liver Injury". J Clin Exp Hepatol. 2 (3): 247–59. doi:10.1016/j.jceh.2012.05.002. PMC 3940315. PMID 25755441.