Table 3.
Comparison between drug-induced autoimmune hepatitis and drug-induced liver injury
|
Clinical features
|
DIAIH
|
DILI
|
| Demographics | ||
| Female, % | 62%[37] | 48% (P = 0.162)[37] |
| Age (yr), mean ± SD | 57± 17[37]; 59 ± 17[22] | 54 ± 18 (P = 0.550)[37]; 47 (P = 0.002)[22] |
| Clinical presentation | ||
| Jaundice, % | 69%[37]; 68%[15]; 66%[16] | 69% (P = 0.953)[37]; 56% (P = 0.4)[15]; 40%-47.6% (P = 0.2)[16] |
| Rash, % | 4.5%[37]; 19%[15] | 7.9% (P = 1.000)[37]; 22% (P = 0.7)[15] |
| Hepatocellular injury, % | 92%[37] | 57% (P = 0.002)[37] |
| Latency period (d), median (range) | 65 (27-274)[37]; 277 (8-7032)[15]; 4 (1-9)[16] | 27 (8-64) (P = 0.004)[37]; 100 (13-1572) (P = 0.03)[15]; 7-10 (5-50) (P = 0.7)[16] |
| Latency period (d), mean ± SD | 143 ± 188[22] | 32 ± 120 (P = 0.000)[22] |
| Culprit drug due to CAM, % | 70%[22] | 25% (P = 0.000)[22] |
| Biochemical results | ||
| ALT × ULN, mean ± SD | 28 ± 19[37] | 19 ± 22 (P = 0.0002)[37] |
| AST × ULN, mean ± SD | 24 ± 17[37] | 15 ± 21 (P = 0.0001)[37] |
| Autoimmune antibodies and serology | ||
| Detectable ANA, % | 88%[37]; 72%[15]; 52%[22] | 12 (P < 0.001)[37]; 22[15]; 15 (P = 0.003)[22] |
| Detectable ASMA, % | 44%[37]; 60%[15] | 8.9% (P < 0.001)[37]; 13%[15] |
| Detectable AMA, % | 4%[37] | 1.9% (P = 0.397)[37] |
| Detectable anti-LKM-1, % | 0%[37] | 1.1% (P = 1.000)[37] |
| Elevated IgG, % | 39%[15]; (25% > 1.1 × ULN)[15] | 9%[15] |
| Serum IgG (g/L), mean ± SD | 19.5 ± 10.7[37]; 1.07 × ULN ± 0.51[22] | 11.9 ± 4.6 (P < 0.001)[37]; 0.69 × ULN ± 0.28 (P = 0.000)[22] |
| Histopathology | ||
| Liver biopsy[16] | ||
| Severe portal inflammation, % | 100% | 56.2%-62.5% |
| Prominent portal plasma cells, % | 58.3% | 6.3%-12.5% |
| Rosette formation, % | 66.7% | 6.3%-12.5% |
| Severe focal necrosis, % | 66% | 6.3%-25% |
| Treatment and response to treatment | ||
| Corticosteroid therapy, % | 43%[15] | 61% (P = 0.3)[15] |
| Immunosuppressive therapy, (corticosteroid/Azathioprine), % | 58%[37]; 60.8%[22] | 9.9% (P < 0.001)[37]; 10.3% (P = 0.000)[22] |
| Outcomes | ||
| Mild/mod/severe DILI, % | 35%/45%/7.7%[37] | 31%/59%/6.2% (P = 0.784)1[37] |
| Outcomes (liver transplant/death), % | 3.8%/0%[37]; 6%/4%[15] | 2.1%/1.5% (P = 0.784)1[37]; 0/0 (P = 0.6 for liver transplant, P = 1.0 for death)[15] |
| Chronicity rate, % | 17%[15] | 21% (P = 0.70)[15] |
1
Combined comparisons of severity of drug-induced liver injury, mortality, and liver transplantation.
DIAIH: Drug-induced autoimmune hepatitis; DILI: Drug-induced liver injury; ALT: Alanine transaminase; AST: Aspartate transaminase; ULN: Upper limit of normal; CAM: Complementary alternative medicines; Anti-LKM: Anti-liver kidney antibody; SD: Standard deviation; IAIHG: International AIH Group.