Retrospective evaluation of clinical characteristics and course of pediatric patients diagnosed with drug-associated liver injury (DILI)

Retrospective Evaluation of Clinical Characteristics and Course of Pediatric Patients Diagnosed with Drug-Associated Liver Injury (DILI) Drug-induced liver injury (DILI) is defined as liver damage caused by various drugs after exclusion of other etiologies. There is limited literature regarding DILI in the pediatric population. This study aimed to evaluate the clinical and laboratory, and outcome results of patients aged 1-18 years with DILI. This study was planned retrospectively, and 28 patients diagnosed with DILI between 2017 and 2022 at Koç University Faculty of Medicine, Pediatric Gastroenterology, Hepatology and Nutrition clinic were included. Age, gender, height, weight, constantly used medication, clinical history, laboratory findings, and radiological imaging information of the patients were recorded. All data obtained were evaluated by SPSS 29. The average age of the patients was 8.1±5.6 (1-17) years, 17 (60.7%) were boys and 11 (39.3%) were girls. 14.3% of patients had a body mass index >85p and were overweight. The most frequently used drug consistently as a cause of DILI was Trimethoprim-Sulfomethoxazole (n=17.9%), and the most frequently used suspected drug was ceftriaxone (n=17.9%). After an average of 4 days (2-50 days) of drug use, the average Alanine Amino Transferase (ALT), Aspartate Amino Transferase (AST), Gamma Glutamyl Transferase (GGT) and Lactate Dehydrogenase (LDH) levels were determined as 638.9±1538.6 IU. , respectively. It was determined as 603.2±1846.6 IU, 192.5±279.4 IU, 412.5±475.6 IU. According to the RUCAM value, 10.8% of the patients had mixed, 39.2% cholestatic, and 50% had hepatocellular damage. The active ingredient was discontinued in all patients, and vitamin E and ursodeoxycholic acid treatment was administered starting from the moment of admission until n-acetyl cysteine increased to twice the normal level and enzyme values returned to normal. While enzymes returned to normal in 88% of the patients in an average of 17 (4-22) days, a chronic course (>6 months) was detected in 12%. No patients died during follow-up.Preliminary findings of the study suggest that although antimicrobial agent are the most common cause of DILI, the R value may be a tool to indicate disease severity and survival in children. Studies in larger groups are needed on this subject. Key Words: Drug induced liver injury, child, RUCAM score