Clinical features of different types of drug-induced liver injury and their association with liver histological changes

Objective To investigate the clinical features of patients with different clinical types of drug-induced liver injury (DILI) , as well as the association between clinical type and pathological type.Methods A total of 289 patients with DILI who were admitted to Tianjin Second People's Hospital from January 2014 to January 2016 were enrolled, and according to the“R value”calculated based on biochemical parameters, they were divided into hepatocellular injury type group, cholestasis type group, and mixed type group.Medications and biochemical parameters were summarized and the liver histological changes in patients undergoing biopsy were observed to investigate the consistency between pathological type and clinical type.The non-parametric Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and a one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups.The chi-square test was used for comparison of categorical data between groups.Results According to the calculated“R value”, of all patients, 181 (62.63%) had hepatocellular injury type, 55 (19.03%) had cholestasis type, and 53 (18.34%) had mixed type.Most of the drugs that caused liver injury were traditional Chinese medicine (48.79%) .A total of 152 patients underwent biopsy, and according to the histological changes, 43 (28.29%) had hepatocellular injury type, 8 (5.26%) had cholestasis type, and 101 (66.45%) had mixed type;among these patients, the calculation of the “R value”showed that 95 (62.50%) had hepatocellular injury type, 29 (19.08%) had cholestasis type, and 28 (18.42%) had mixed type.There was a poor consistency between pathological type and clinical type (κ=0.229, P<0.05) .Conclusion Traditional Chinese medicine is the main cause of DILI.There is a poor consistency between clinical type and pathological type of DILI, and the most common pathological type is mixed type.Therefore, the criteria for clinical typing await further improvement.