Drug-induced liver injury in children:An analysis of medication and clinical features

Objective To investigate the drugs responsible for drug-induced liver injury ( DILI) in children and related risk factors, andto provide a reference for safe drug use in children in clinical practice. Methods A retrospective analysis was performed for the clinical da-ta of 187 children with DILI, aged 0-14 years, who were treated in The Fifth Medical Center of Chinese PLA General Hospital from January2008 to December 2017, including medication history, biochemical parameters, symptoms/signs, and clinical outcome. Based on the meth-od of integrated evidence chain, 127 children with medication information were divided into Western medicine-induced DILI group ( West-ern medicine group with 75 children) , traditional Chinese medicine ( TCM) -induced DILI group ( TCM group with 15 children) , and thegroup with DILI induced by Western medicine and TCM ( TCM-Western medicine group with 37 children) . The reason for medication, medication time, latency of DILI, and drug classification were compared between groups. The Kruskal-Wallis H test was used for compari-son of continuous data with skewed distribution between multiple groups, and the Nemenyi test was used for further comparison between twogroups; the chi-square test was used for comparison of categorical data between groups. Results Of all 187 children with DILI, 116 ( 62%) had severe liver injury or above, among whom 3 underwent liver transplantation and 1 died, and 45 ( 24%) developed chronicity.In the Western medicine group and the TCM-Western medicine group, major suspected drugs for DILI were antibiotics, antipyretics, anal-gesics, and anti-inflammatory drugs, which accounted for 42%, 30%, 56%, and 31%, respectively. In the TCM group, the most com-mon TCM drugs for DILI were those used to treat skin diseases, which accounted for 47% and were mainly the preparations of Fallopia multi-flora ( 33%) . There were significant differences between the three groups in medication time ( H = 11. 658, P = 0. 003) and latency ( H =10. 945, P = 0. 004) , and the TCM group had significantly longer medication time and latency than the other two groups ( all P < 0. 05) .Conclusion Most children with DILI have serious conditions. The risk of liver injury due to medication in children should be taken serious-ly, and particular emphasis should be placed on the risk of liver injury caused by antibiotics, antipyretics, analgesics, and anti-inflamma-tory drugs and long-term use of some TCM drugs for skin diseases.