1
|
Giunta DH, Karlsson P, Younus M, Berglind IA, Kieler H, Reutfors J. Validation of diagnoses of liver disorders in users of systemic azole antifungal medication in Sweden. BMC Gastroenterol 2024; 24:21. [PMID: 38182992 PMCID: PMC10770890 DOI: 10.1186/s12876-023-03110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Liver disorders are important adverse effects associated with antifungal drug treatment. However, the accuracy of Clinical International Classification of Diseases (ICD)-10 codes in identifying liver disorders for register based research is not well-established. This study aimed to determine the positive predictive value (PPV) of the ICD-10 codes for identifying patients with toxic liver disease, hepatic failure, and jaundice among patients with systemic antifungal treatment. METHODS Data from the Swedish Prescribed Drug Register and the National Patient Register were utilized to identify adult patients who received systemic azole antifungal drugs and had a recorded diagnosis of toxic liver disease (K71.0, K71.1, K71.2, K71.6, K71.8, K71.9), hepatic failure (K72.0, K72.9), or jaundice (R17) between 2005 and 2016. The medical records of all included patients were reviewed. Prespecified criteria were used to re-evaluate and confirm each diagnosis, serving as the gold standard to calculate PPVs with 95% confidence intervals (95% CI) for each diagnostic group. RESULTS Among the 115 included patients, 26 were diagnosed with toxic liver disease, 58 with hepatic failure, and 31 with jaundice. Toxic liver disease was confirmed in 14 out of 26 patients, yielding a PPV of 53.8% (95% CI 33.4-73.4%). Hepatic failure was confirmed in 26 out of 38 patients, resulting in a PPV of 62.1% (95% CI 48.4-74.5%). The highest PPV was found in jaundice, with 30 confirmed diagnoses out of 31, yielding a PPV of 96.8% (95% CI 83.3-99.9%). CONCLUSION Among patients who received azole antifungal treatment and were subsequently diagnosed with a liver disorder, the PPV for the diagnosis of jaundice was high, while the PPVs for toxic liver disease and hepatic failure were lower.
Collapse
Affiliation(s)
- Diego Hernan Giunta
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital T2:02, 171 76, Stockholm, Sweden.
| | - Pär Karlsson
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital T2:02, 171 76, Stockholm, Sweden
| | - Muhammad Younus
- Safety Surveillance Research, Worldwide Medical and Safety, Pfizer Inc, Collegeville, PA, USA
| | - Ina Anveden Berglind
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital T2:02, 171 76, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital T2:02, 171 76, Stockholm, Sweden
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital T2:02, 171 76, Stockholm, Sweden
| |
Collapse
|
2
|
Li FC, Lee SL, Lin HM, Lin CJ, Wang SS, Lee YY, Lo SY, Sun TL, Chen WL, Lo W, Horton N, Xu C, Chiang SJ, Chen YF, Lee HS, Dong CY. Dynamic visualization of the recovery of mouse hepatobiliary metabolism to acetaminophen-overdose damage. JOURNAL OF BIOPHOTONICS 2019; 12:e201800296. [PMID: 30302934 DOI: 10.1002/jbio.201800296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Abstract
Acetaminophen (APAP) overdose is one of the world's leading causes of drug-induced hepatotoxicity. Although traditional methods such as histological imaging and biochemical assays have been successfully applied to evaluate the extent of APAP-induced liver damage, detailed effect of how APAP overdose affect the recovery of hepatobiliary metabolism and is not completely understood. In this work, we used intravital multiphoton microscopy to image and quantify hepatobiliary metabolism of the probe 6-carboxyfluorescein diacetate in APAP-overdose mice. We analyzed hepatobiliary metabolism for up to 7 days following the overdose and found that the excretion of the probe molecule was the most rapid on Day 1 following APAP overdose and slowed down on Days 2 and 3. On Day 7, probe excretion capability has exceeded that of the normal mice, suggesting that newly regenerated hepatocytes have higher metabolic capabilities. Our approach may be further developed applied to studying drug-induced hepatotoxicity in vivo.
Collapse
Affiliation(s)
- Feng-Chieh Li
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Sheng-Lin Lee
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Hung-Ming Lin
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Chih-Ju Lin
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Sheng-Shun Wang
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Yu-Yang Lee
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Su-Yen Lo
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Tzu-Lin Sun
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Wen Lo
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Nicholas Horton
- School of Engineering and Applied Physics, Cornell University, Ithaca, New York
| | - Chris Xu
- School of Engineering and Applied Physics, Cornell University, Ithaca, New York
| | - Shu-Jen Chiang
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Yang-Fang Chen
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Hsuan-Shu Lee
- Institute of Biotechnology, National Taiwan University, Taipei, Taiwan, Republic of China
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Chen-Yuan Dong
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
- Center for Optoelectronic Biomedicine, National Taiwan University, Taipei, Taiwan, Republic of China
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan, Republic of China
| |
Collapse
|
3
|
Chalin A, Lefevre B, Devisme C, Pronier C, Carrière V, Thibault V, Amiot L, Samson M. Serum CXCL10, CXCL11, CXCL12, and CXCL14 chemokine patterns in patients with acute liver injury. Cytokine 2018; 111:500-504. [DOI: 10.1016/j.cyto.2018.05.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 02/08/2023]
|
4
|
Wendon, J, Cordoba J, Dhawan A, Larsen FS, Manns M, Samuel D, Simpson KJ, Yaron I, Bernardi M. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol 2017; 66:1047-1081. [PMID: 28417882 DOI: 10.1016/j.jhep.2016.12.003] [Citation(s) in RCA: 478] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 02/06/2023]
Abstract
The term acute liver failure (ALF) is frequently applied as a generic expression to describe patients presenting with or developing an acute episode of liver dysfunction. In the context of hepatological practice, however, ALF refers to a highly specific and rare syndrome, characterised by an acute abnormality of liver blood tests in an individual without underlying chronic liver disease. The disease process is associated with development of a coagulopathy of liver aetiology, and clinically apparent altered level of consciousness due to hepatic encephalopathy. Several important measures are immediately necessary when the patient presents for medical attention. These, as well as additional clinical procedures will be the subject of these clinical practice guidelines.
Collapse
|
5
|
Shahraki MR, Irani M. The effects of ecstasy on liver function tests, blood glucose, and lipids profile of male rats. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2014; 3:e21076. [PMID: 25741481 PMCID: PMC4331654 DOI: 10.5812/ijhrba.21076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/20/2014] [Accepted: 07/26/2014] [Indexed: 11/30/2022]
Abstract
Background: Ecstasy is used to improve mood and cordiality; however, based on some reports, it is neurotoxic to human users. Objectives: Because of the euphoria induced by MDMA (3,4-methylenedioxymethamphetamine) on the users, its consumption is increasing in almost all countries. This study was carried out to determine the effects of ecstasy administration in rats’ blood sugar, lipids profile, and liver function tests. Materials and Methods: The experiment was performed using 50 mature Wistar-Albino male rats. The rats were divided into five groups (n = 10). Sham control group (A), received tap water and ordinary rodent diet. The control (B) was administered saline but tests group C, D1, and D2 received single dose and multiple doses of MDMA, respectively. After experimental period, animals were deeply anesthetized by diethyl ether, sacrificed and the blood samples were collected for the evaluation of blood glucose, serum lipid and aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALK-P). Data were expressed as mean ± SD and statistical difference was considered significant at P < 0.05. Results: In C group, the values of blood sugar (193.8 ± 11.6 mg/dL), low density lipoprotein (LDL) (19.2 ± 7.9 mg/dL), and cholesterol (76.1 ± 10.6 mg/dL), were significantly increased compared with those of control A and B (135 ± 12.7), (140 ± 18.8), and (45.4 ± 9.8), (49.8 ± 2.1) (49.4 ± 10.6) groups. However, aspartate transaminase (AST) and alanine transaminase (ALT) were significantly increased in groups D1 (145.8 ± 14.7 U/L), (91.1 ± 8.1 U/L), and D2 (159.4 ± 13.8 U/L) and (75.4 ± 7.8) compared with those of group A (107.2 ± 8.1), (45.4 ± 9.8), B (79.8 ± 12.1), (49.8 ± 2.1), and C (115.6 ± 17.5), (52.1 ± 7.6 U/L). Cholesterol and LDL increased in groups C and D compared with group A. Conclusions: These results indicated that chronic administration of MDMA affects liver as well as lipoprotein profile in male rats. The exact mechanism of action needs further investigation.
Collapse
Affiliation(s)
- Mohammad Reza Shahraki
- Department of Physiology, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding author: Mohmmad Reza Shahraki, Department of Physiology, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-5413414552-5, Fax: +98-5413414563, E-mail:
| | - Mahdieh Irani
- Zahedan Health Service Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| |
Collapse
|
6
|
Rajput I, Prasad KR, Bellamy MC, Davies M, Attia MS, Lodge JPA. Subtotal hepatectomy and whole graft auxiliary transplantation for acetaminophen-associated acute liver failure. HPB (Oxford) 2014; 16:220-8. [PMID: 23870048 PMCID: PMC3945847 DOI: 10.1111/hpb.12124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 03/17/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND An acetominophen overdose (AOD) is the leading cause of acute liver failure (ALF) in the UK and USA. For patients who meet the King's College Hospital criteria, (mortality risk > 85%), an emergency orthotopic liver transplantation (OLT) is conventionally performed with subsequent life-long immunosuppression. A new technique was developed in 1998 for AOD-induced ALF where a subtotal hepatectomy (right hepatic trisectionectomy) and whole graft auxiliary liver transplant (WGALT) was performed with complete withdrawal of immunosupression during the first year post-operatively. RESULTS During 1998-2010, 68 patients were listed for an emergency transplantation for AOD ALF at our institution: 28 died waiting, 16 underwent OLT and 24 a subtotal hepatectomy with WGALT. Eight OLT (50%) and 16 WGALT remain alive (67%); actuarial survival at 5 years OLT 50%, WGALT 63%, P = 0.37. All patients who had successful WGALT are off immunosuppression. Poor prognostic factors in the WGALT group included higher donor age (40.4 versus 53.9, P = 0.043), requirements for a blood transfusion (4.3 versus 7.6, P = 0.0043) and recipient weight (63.1 versus 54 kg, P = 0.036). CONCLUSION Although OLT remains standard practice for AOD-induced ALF, life-long immunosuppression is required. A favourable survival rate using a subtotal hepatectomy and WGALT has been demonstrated, and importantly, all successful patients have undergone complete immunosuppression withdrawal. This technique is advocated for patients who have acetominophen hepatotoxicity requiring liver transplantation.
Collapse
Affiliation(s)
- Ibrahim Rajput
- HPB and Transplant Unit, St. James's University HospitalLeeds, UK
| | | | - Mark C Bellamy
- Department of Anaesthesia, St. James's University HospitalLeeds, UK
| | - Mervyn Davies
- Department of Hepatology, St. James's University HospitalLeeds, UK
| | - Magdy S Attia
- HPB and Transplant Unit, St. James's University HospitalLeeds, UK
| | - J Peter A Lodge
- HPB and Transplant Unit, St. James's University HospitalLeeds, UK
| |
Collapse
|
7
|
Warrillow SJ, Bellomo R. Preventing cerebral oedema in acute liver failure: the case for quadruple-H therapy. Anaesth Intensive Care 2014; 42:78-88. [PMID: 24471667 DOI: 10.1177/0310057x1404200114] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Severe cerebral oedema is a life-threatening complication of acute liver failure. Hyperammonaemia and cerebral hyperaemia are major contributing factors. A multimodal approach, which incorporates hyperventilation, haemodiafiltration, hypernatraemia and hypothermia (quadruple-H therapy), may prevent or attenuate severe cerebral oedema. This approach is readily administered by critical care clinicians and is likely to be more effective than the use of single therapies. Targeting of PaCO2 in the mild hyperventilation range, as seen in acute liver failure patients before intubation, aims to minimise hyperaemic cerebral oedema. Haemodiafiltration aims to achieve the rapid control of elevated blood ammonia concentrations by its removal and to reduce production via the lowering of core temperature. The administration of concentrated saline increases serum tonicity and further reduces cerebral swelling. In addition, the pathologically increased cerebral blood-flow is further attenuated by therapeutic hypothermia. The combination of all four treatments in a multimodal approach may be a safe and effective means of attenuating or treating the cerebral oedema of acute liver failure and preventing death from neurological complications.
Collapse
Affiliation(s)
- S J Warrillow
- Department of Intensive Care, Austin Health, Victoria, Australia
| | | |
Collapse
|
8
|
Park JH, Seo KS, Tadi S, Ahn BH, Lee JU, Heo JY, Han J, Song MS, Kim SH, Yim YH, Choi HS, Shong M, Kweon G. An indole derivative protects against acetaminophen-induced liver injury by directly binding to N-acetyl-p-benzoquinone imine in mice. Antioxid Redox Signal 2013; 18:1713-22. [PMID: 23121402 PMCID: PMC3619205 DOI: 10.1089/ars.2012.4677] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIMS Acetaminophen (APAP)-induced liver injury is mainly due to the excessive formation of reactive oxygen species (ROS) and reactive nitrogen species (RNS) through the formation of a reactive intermediate, N-acetyl-p-benzoquinone imine (NAPQI), in both humans and rodents. Here, we show that the indole-derived synthetic compound has a protective effect against APAP-induced liver injury in C57Bl/6 mice model. RESULTS NecroX-7 decreased tert-butylhydroperoxide (t-BHP)- and APAP-induced cell death and ROS/RNS formation in HepG2 human hepatocarcinoma and primary mouse hepatocytes. In mice, NecroX-7 decreased APAP-induced phosphorylation of c-Jun N-terminal kinase (JNK) and 3-nitrotyrosine (3-NT) formation, and also protected mice from APAP-induced liver injury and lethality by binding directly to NAPQI. The binding of NecroX-7 to NAPQI did not require any of cofactors or proteins. NecroX-7 could only scavenge NAPQI when hepatocellular GSH levels were very low. INNOVATION NecroX-7 is an indole-derived potent antioxidant molecule, which can be bound to some types of radicals and especially NAPQI. It is well known that the NAPQI is a major intermediate of APAP, which causes necrosis of hepatocytes in rodents and humans. Thus, blocking NAPQI formation or eliminating NAPQI are novel strategies for the treatment or prevention of APAP-induced liver injury instead of GSH replenishment. CONCLUSION Our data suggest that the indole-derivative, NecroX-7, directly binds to NAPQI when hepatic GSH levels are very low and the NAPQI-NecroX-7 complex is secreted to the blood from the liver. NecroX-7 shows more preventive and similar therapeutic effects against APAP-induced liver injury when compared to the effect of N-acetylcysteine in C57Bl/6 mice.
Collapse
Affiliation(s)
- Ji-Hoon Park
- Department of Biochemistry, School of Medicine, Chungnam National University, Daejeon, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Shahidul Islam M, Nishiyama A, Sakaguchi E. Sorbitol and lactitol reduce body fat and toxic ammonia levels in rats. Nutr Res 2007. [DOI: 10.1016/j.nutres.2007.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|