Todavía se recetan medicamentos potencialmente hepatotóxicos a pacientes con enfermedad hepática que reciben atención terciaria: es hora de decir basta

Introduction and aim: Drug-induced liver injury (DILI) manifests as a spectrum of clinical presentations that carries morbidity and mortality. Patients with chronic liver disease (CLD), particularly hospitalized, are at high risk for developing DILI. We aimed to investigate the use of potentially hepatotoxic drugs (PHD) in patients with CLD in a tertiary university hospital. Materials and methods: Adult (≥ 18 years-old) with CLD admitted to the hospital from January 2016 to December 2018 were evaluated regarding PHD, assessing the risk of DILI and liver enzymes behavior after exposure. Results: From 931 hospitalized patients with CLD, 291 (31.3%) were exposed to hepatotoxic drugs during their hospitalization. Of those, 244 (83.8%) were cirrhotic. The most frequent causes of liver disease were hepatitis C (41.2%), followed by alcohol (13.2%), hepatitis C/alcohol (11.7%) and non-alcoholic fatty liver disease (5.8%). Decompensated cirrhosis (46.7%) was the main reason for hospital admission. The most often prescribed PHD were antibiotics (67.7%), cardiovascular drugs (34.4%), neuromodulators (26.1%) and anesthetics (19.9%). After exposure, 113 patients (38.8%) presented significant elevated liver enzymes. Surprisingly, PHD were more often prescribed in GI/Liver unit (48.8%) followed by emergency/intensive care unit (28.5%). A total of 65 patients (22%) died, however in neither case was it possible to safely infer causal relationship among PHD, liver enzymes and death. Conclusion: PHD prescription is frequent in patients with CLD even in a tertiary university hospital and in the gastroenterology and hepatology department, exposing these patients to an additional risk.Introducción y objetivo: La lesión hepática inducida por fármacos (DILI) se manifiesta como un espectro de presentaciones clínicas que conlleva morbilidad y mortalidad. Los pacientes con enfermedad hepática crónica (EHC), en particular hospitalizados, tienen un alto riesgo de desarrollar DILI. Nuestro objetivo fue investigar el uso de fármacos potencialmente hepatotóxicos (FPH) en pacientes con EHC en un hospital universitario terciario. Materiales y métodos: Se evaluó la expossición a FPH en adultos (≥ 18 años) con EHC ingresados en el hospital entre enero de 2016 y diciembre de 2018, evaluando el riesgo de DILI y el comportamiento de las enzimas hepáticas tras la exposición. Resultados: De 931 pacientes hospitalizados con EHC, 291 (31,3%) estuvieron expuestos a fármacos hepatotóxicos durante su hospitalización. De ellos, 244 (83,8%) eran cirróticos. Las causas más frecuentes de enfermedad hepática fueron la hepatitis C (41,2%), seguida del alcohol (13,2%), la hepatitis C / alcohol (11,7%) y la enfermedad del hígado graso no alcohólico (5,8%). La cirrosis descompensada (46,7%) fue el principal motivo de ingreso hospitalario. Los FPH más prescritos fueron antibióticos (67,7%), fármacos cardiovasculares (34,4%), neuromoduladores (26,1%) y anestésicos (19,9%). Tras la exposición, 113 pacientes (38,8%) presentaron elevación significativa de las enzimas hepáticas. Sorprendentemente, los FPH se prescribieron con mayor frecuencia en la unidad GI / Hígado (48,8%) seguido de la unidad de emergencia / cuidados intensivos (28,5%). Un total de 65 pacientes (22%) fallecieron, sin embargo, en ninguno de los casos fue posible inferir con seguridad la relación causal entre el FHD, las enzimas hepáticas y la muerte. Conclusión: la prescripción de FPH es frecuente en pacientes con EHC incluso en un hospital universitario terciario y en el servicio de gastroenterología y hepatología, exponiendo a estos pacientes a un riesgo adicional

A global research priority agenda to advance public health responses to fatty liver disease

Background & aims An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community. Methods Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy. Results The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of ‘agree’ responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement (‘agree’ + ‘somewhat agree’); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% ‘agree’), 13 priorities had 90% combined agreement. Conclusions Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community’s efforts to advance and accelerate responses to this widespread and fast-growing public health threat. Impact and implications An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat