Etiology of New-Onset Jaundice: How Often Is It Caused by Idiosyncratic Drug-Induced Liver Injury in The United States?

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Abstract

BACKGROUND AND AIM

The epidemiology of acute drug-induced liver injury (DILI) in the United States has not been well studied. We conducted a study of adults with new-onset jaundice at a nonreferral community hospital to better understand the epidemiology of acute DILI.

METHODS

This is a retrospective study of adult outpatients and inpatients (≥18 yr) with new-onset jaundice over a 5-yr period (1999–2003) at Wishard Memorial Hospital, Indiana. Patients with new-onset jaundice were identified using our electronic medical record system and individual medical records were reviewed to extract the required clinical data. New-onset jaundice was defined as the presence of total serum bilirubin >3 mg/dL in patients without a prior total bilirubin >3 mg/dL.

RESULTS

A total of 732 eligible adults constituted our study cohort. Sepsis or altered hemodynamic state resulting in presumed ischemic liver injury is the single most common cause of jaundice (22%). Acute liver disease as a result of nonalcoholic etiologies caused new-onset jaundice in 97 patients (13%), with acute viral hepatitis in 66 patients (9%) and DILI in 29 patients (4%). Most cases of DILI were as a result of acetaminophen toxicity with idiosyncratic DILI occurring in only five patients (0.7%). No mortality was observed at 6 wk in patients who developed idiosyncratic DILI.

CONCLUSION

Idiosyncratic DILI appears to be a rare cause of new-onset jaundice in a community hospital setting.

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