Risk factors, management and outcomes of drug induced hepatic injury among adult patients with liver disease at Kenyatta National Hospital

Abstract

Background: Globally, liver injury due to medicines is a growing medical, scientific and public health problem. Over the past two decades, reports from World Health Organization have shown that there has been a rising number of patients with drug induced liver disease. Published literature on the local prevalence of possible drug-induced liver disease cases, associated risk factors as well as management of these conditions remains scanty. Study Objectives: To assess drug induced liver disease in adult patients with liver disease with respect to the prevalence, risk factors, management and outcomes. Study Design: A cross-sectional survey of adult patients with liver disease. Study Area: Kenyatta National Hospital Liver Clinic and Medical Wards. Study Population: Four hundred and eighty five patients (485) aged 18 years and above, with diagnosed liver disease who met the study inclusion criteria. Methods: Patients attending the liver clinic were recruited consecutively as they came for their appointments. Those in the medical wards were selected consecutively using the admission list and then followed into the wards using their names and patient numbers. Results: There were slightly more males, at 257(53.1%), than females. The mean age of the study participants was 41.4 years (± 14.1). Majority of patients (59.8%) had hepatocellular injury and presented with elevated liver enzymes (97 %) and jaundice (78.4 %). The most frequently used and suspected drug causing liver disease among patients was alcohol at 37.7 %. However, the use of antiretrovirals (OR=0.31; 95 % CI: 0.17-0.57; p=0.05) and alcohol (OR=0.56; 95 % CI: 0.35-0.89; p=0.05) increased the likelihood of having an admission, relapse or death among patients by 31% and 56% respectively. Most of the management strategies (90.9%) was by withdrawal of the offending agent. Other strategies included use of steroids(OR=2.30;95% CI:1.46-3.64;p<0.00001), antihistamines(OR=4.52; 95% CI: 1.85-11.02;p<0.00001) and vitamin K(OR=3.09; 95% CI:1.82-5.22;p<0.00001) and these were found to increase the likelihood of having a desirable outcome by two times, five times and three times respectively. More than half (55.5 %) of the patients were admitted for more than 10 days during management and mortality was at 7%.