Effect of glucocorticoid in the treatment of severe drug-induced liver injury

ObjectiveTo investigate the therapeutic effect of glucocorticoid in patients with severe drug-induced liver injury (DILI). Methods A retrospective analysis was performed for the data of patients with severe DILI who were admitted to The First Hospital of Shanxi Medical University from January 2019 to September 2021, including demographic characteristics, drugs inducing liver injury, and clinical manifestations, and changes in liver function, treatment outcome, and adverse reactions were compared between the patients treated with glucocorticoid (glucocorticoid group) and those not treated with glucocorticoid (control group). The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. ResultsA total of 88 patients with DILI were included in analysis, among whom there were 33 male patients and 55 female patients, with a median age of 49 years, and there were 61 patients in the control group and 27 patients in the glucocorticoid group. Hepatocellular injury type was the main clinical type, and traditional Chinese medicine and dietary supplements were the most common drugs inducing liver injury. Main clinical manifestations included jaundice, nausea, and poor appetite, and 6 patients (6/88, 6.82%) progressed to grade 4 DILI, with 2 patients in the glucocorticoid group and 4 in the control group. The comparison of baseline characteristics showed that there were significant differences between the glucocorticoid group and the control group in aspartate aminotransferase, gamma-glutamyl transpeptidase (GGT), total bilirubin (TBil), and the proportion of patients with positive immune indices (all P＜0.05). On day 3 of treatment, there were significant differences between the two groups in the reduction rates of TBil, international normalized ratio (INR), and total bile acid (TBA) (all P＜0.05); on day 7 of treatment, there were significant differences between the two groups in the reduction rates of alanine aminotransferase, GGT, INR, and TBA (all P＜0.05). Compared with the control group, the glucocorticoid group had a significantly higher cumulative response rate on days 3 and 7 of treatment (day 3: 59.26% vs 29.51%, χ2=5582, P=0.008; day 7: 81.48% vs 29.51%, χ2=64.27, P＜0.001). In the glucocorticoid group, the 2 patients with grade 4 DILI showed no response, while treatment response was observed in 93.75% of the patients who were treated with glucocorticoid due to the reduction in liver enzymes and the persistent increase (or a lack of significant reduction) in bilirubin after conventional liver-protecting treatment. ConclusionTraditional Chinese medicine and dietary supplements are the most common drugs inducing liver injury, and short-term use of glucocorticoids may bring benefits to the patients with grade 3 DILI who fail to achieve a satisfactory reduction in bilirubin after conventional treatment.