Drugs Confirmed a Leading Cause of Severe Liver Injury
New research from China’s Zhejiang University School of Medicine has found that pharmaceutical drugs are a leading cause for severe liver injury even in China where pharmaceutical use is less than in the U.S.
The researchers studied severe liver injury cases that occurred in the Zhejiang Affiliated Hospital over a period of twelve months. Severe liver injury was determined by alanine aminotransferase (ALT) liver enzyme levels that were more than ten times the highest normal range. Such levels indicate severe trauma to the liver.
Over the year, the researchers found 129 cases of severe liver injury where the ALT liver enzymes were ten times the highest normal levels. Of these, they found that 25 of the cases, about 20%, were caused by drugs – labeled “drug induced liver injury.”
The leading cause was hemodynamic injury. This means damage to some part of blood flow, typically related to cardiovascular disease or diabetes. However, these causes can also be related to pharmaceutical use, as well as poor dietary habits, smoking, lack of exercise and so on.
Behind these two causes were cancer, abnormal bile ducts or bile production, and hepatitis. Hepatitis was the cause of 12 cases, or about 9%. The remaining 10 cases of severe liver injury – or about 8% – their cause was not determined.
Of the 25 cases of drug induced liver injury, eight cases were caused by antibiotics. These included furbenicillin, cefminox, ornidazole, panipenem, betamipron, meropenem, piperacillin, sulbactam and cefoxitin. This was followed by glucorticoid drugs such as methylprednisolone. After these, pain-relieving drugs including diclofenac, celecoxib, parecoxib and baclofen. Three cases were caused by cardiovascular drugs and two cases were caused by proton pump inhibitors. Two cases were caused by nervous system drugs.
The research also found six cases were related to herbal medicine extracts. Because Chinese medicine often uses herbal medicines extracted using ethanol and methanol, these can sometimes cause liver injury when the doses are high.
Liver injury from pharmaceutical drugs is significantly higher in the U.S. In a 2002 study, data from the U.S. Acute Liver Failure Study Group found that of 308 patients from 17 clinics who suffered from acute liver failure, 39% were caused by acetaminophen use or overuse. Other drugs caused liver failure in another 13%, making for a total of 52% of acute liver failure being drug-induced. Other causes included hepatitis. In 17% of the cases, the cause was not determined.
As far as frequency of liver injury among all patients undergoing medical treatment, researchers from the University Hospital in Zurich studied 6,383 patients who received medical treatment. Out of this group, 88 patients suffered from drug induced liver injury. This represents 1.3 people out of every hundred who receive medical treatment suffering severe drug-induced liver injury. Even after excluding patients without underlying enzyme levels prior to treatment, the number still exceeded one out of every 100 for those receiving medical treatment suffering drug-induced liver injury.
This number becomes astounding when considering the millions of people who receive medical treatment every year. This of course contributes to the more than 100,000 people who die from conventional medical treatment every year in the U.S.
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Reuters. France best, U.S. worst in preventable death ranking. 2008, Jan 8.