Drug induced liver damage in a universitary hospital

Background: Drug Induced Liver Injury (DILI) is responsible for wide spectrum of liver injury. Clinically, these events are presented in various forms and for reaching a different diagnosis other injury causes must be excluded. Aim: Identify and characterize cases of hepatotoxicity induced by drugs, herbal and dietary supplements in University Hospital in Brazil. Material and Methods: Observational and retrospective study. Was collected in records of University Hospital, between August 2009 at August 2014. The causality of the drug reactions suspected were evaluated Council for International Organizations of Medical Sciences (CIOMS). Results: We selected 30 suspected cases, 50% was female and average was 39 years. The therapeutic classes most common was: anti-infectives; antineoplastic agents; central nervous system drugs, anabolic steroid and herbal and dietary supplements (HDS). Cholestatic or mixed injury was observed in 73% these cases; 60% were highly probable, according to CIOMS.  Conclusion: DILI is caused by a wide variety of drugs, dietary supplements and dietary supplements. Anti-infectives and chemotherapy were responsible for much of the respons

Frequência de hepatite fulminante por medicamentos alopáticos, fitoterápicos, insumos vegetais e complementos alimentares em centros de referência no Brasil: resultados preliminares

A insuficiência hepática aguda ou hepatite fulminante caracteriza-se pela rápida perda da função hepática. Tem diversas etiologias metabólicas, destacando-se as hepatites virais e a hepatite induzida por drogas (DILI). De acordo com a O.M.S. no período de 35 anos a insuficiência hepática fulminante relacionada a DILI tem sido relatada principalmente pelo uso de medicamentos, tais como: paracetamol, flutamina, medicamentos fitoterápicos, insumos vegetais e halotano. Embora os relatos de casos de DILI graves sejam frequentes na literatura, poucos são os dados sobre a epidemiologia da DILI grave no Brasil. OBJETIVO: Conhecer a frequência de casos de hepatite fulminante por medicamentos no Brasil. MÉTODO: Estudo transversal retrospectivo multicêntrico. Foi enviado um inquérito por correio eletrônico para cada Centro, perguntando sobre: o tempo de serviço, número de transplantes realizados, número de hepatites fulminantes e suas respectivas etiologias. Posteriormente, cada centro foi visitado para avaliação dos prontuários. RESULTADO: Dos 60 Centros convidados, apenas 05 Centros de Transplante Hepático (C.T.H.), responderam ao inquérito. Foram identificados 51 casos de Insuficiência Hepática Fulminante, 33% (17/51) foram secundários à DILI, destes 02 casos foram secundários ao uso de insumos vegetais. CONCLUSÃO: Os dados preliminares da epidemiologia de DILI no Brasil, são semelhantes aos dados dos Estados Unidos e da Europa. Palavras-Chave: Insuficiência hepática fulminante. Hepatite fulminante. HepatotoxicidadeFulminant hepatitis or fulminant hepatic failure is characterized by rapid loss of liver function. It has different metabolic etiologies, especially viral hepatitis and drug-induced liver injury (DILI) . According to WHO in a period of 35 years fulminant hepatic failure related to DILI has been reported mainly by the use of drugs, such as paracetamol, flutamina, herbal medicines , herbs and halothane . Although case reports of severe DILI are frequent in many countries, there are few data on the epidemiology of severe DILI in Brazil. OBJECTIVE: To determine the frequency of cases of fulminant hepatitis DILI in Brazil. METHODS: Retrospective multicenter study. A survey was sent by electronic mail to each center, asking about: operating time of the unit, number of transplants performed, number of fulminant hepatitis and their causes. Subsequently, each center was visited to review the medical files. RESULTS: Up to now, of the 60 centers invited, only 05 Liver Transplant Centers (HSC) responded to the survey . From these, 51 cases of Fulminant Hepatitis were evaluated. From these, 33 % (17 /51) were identified as possibly DILI. Non- steroidal Anti-inflammatory drugs (NSAIDs) were the most frequent cause of therapeutic class Fulminant hepatitis. Paracetamol was reported in only one case. Two herbal medicines were identified as the cause of liver injury. CONCLUSION: These preliminary data points that DILI epidemiology in Brazil strongly from US and Europe data. Keywords: Fulminant hepatic failure. Fulminant hepatitis. Hepatotoxicity