Etiology of drug-induced hepatotoxicity in children

SUMMARY YILDIRIM S. Etiology of Drug-Induced Hepatotoxicity in Children Karadeniz Technical University Faculty of Medicine, Thesis in Pediatrics. Trabzon 2023. Introduction and Objective: Toxic hepatitis is a liver damage caused by drugs, natural toxins and non-pharmaceutical chemicals while drugs are the most common cause. In general, risk factors consist of drug- and patient-related factors. In our study, we aimed to evaluate the frequency, etiology, risk factors and clinical outcomes of drug-induced liver injury (DILI) in the pediatric age group. Materials and Methods: The study was conducted prospectively in patients with elevated liver enzymes and diagnosed with DILI in pediatric services and outpatient clinics between May 2020 and September 2022. The drugs used by the patients, indications for administration, duration of administration and doses, use of other drugs, exposure to herbal or chemical hepatotoxic agents, and underlying liver disease were recorded. According to the R index (ALT/ALP), liver damage was classified as hepatocellular, mixed and cholestatic type. Results: In our study lasting two years, 1188 of 75,314 patients admitted to the hospital had elevated transaminases (ALT >2 fold) and 300 of these patients were diagnosed DILI. According to this result, the incidence of DILI in the pediatric age group was found to be 17/100.000. The mean age was 7.8±5.5 years, median 7 years (range 0,1 to 17,5 years); 187 (62.3%) were male. 94% of patients were asymptomatic and the most common of symptoms were jaundice (3.3%) and rash (1.7%). The most common drugs causing DILI were antibiotics (53%) whose of used most frequently were cephalosporins (34%) and carbapenems (14%). The other drugs were chemotherapeutics (30.7%), antiepileptics (16.3%), analgesic/anti-inflammatory drugs (8%), immunosuppressive drugs (6%), and hormone treatments (1.3%) respectively. According liver damage, 67% of patients were hepatocelluler type, 27% mixt type and 5% cholestatic type. Conclusion: Antibiotics were the most common drugs causing DILI. The most commonly used drugs in this group were cephalosporins and carbapenems. Hepatocellular type was the most seen liver damage type. Keywords: Drug-induced liver injury, child, hepatocellular hepatitis, cholestatic hepatitis