What Is The Most Common Cause of Liver Injury in Heavy Drinkers?

Anabolic steroid use is the most common cause of idiosyncratic drug-induced liver injury (DILI) in heavy drinkers vs non-drinkers, a new study found. Data also showed that heavy drinkers and non-drinkers with DILI have similar proportions of liver-related death and liver transplantation regardless of alcohol consumption.

Until recently, this association between alcohol intake and idiosyncratic DILI had been unclear.
________________________________________________________________________________

RELATED CONTENT
Acetaminophen-Related Liver Injury, Failure Is More Common in Women
Test for HCV First in Patients With Suspected Drug-Induced Liver Injury
________________________________________________________________________________

From September 2004 to April 2016, the researchers evaluated data on 1198 patients with definite, highly likely, or probable DILI who were enrolled in the Drug-Induced Liver Injury Network (DILIN) prospective study.

Participants reported their alcohol consumption at enrollment, and those who had consumed alcohol within the previous 12 months were administered the Skinner questionnaire in order to assess drinking history. The researchers defined heavy alcohol consumption as, on average, more than 3 drinks per day for men or more than 2 drinks per day for women.

A total of 601 patients had reported consuming at least 1 alcoholic drink in the previous 12 months. Of these patients, 348 completed the Skinner questionnaire and 80 reported heavy alcohol consumption. Results showed that heavy drinkers tended to be younger than non-drinkers (42 years vs 49 years), and a higher proportion of heavy drinkers were men (63% of heavy drinkers vs 35% of non-drinkers).

Ultimately, the researchers found that anabolic steroids were the most frequent cause of DILI in heavy drinkers compared with non-drinkers (13% vs 2%). They also noted that heavy drinkers demonstrated substantially higher peak serum levels of alanine aminotransferase (1323 U/L vs 754 U/L) and higher levels of bilirubin (16.1 mg/dL vs 12.7 mg/dL) vs non-drinkers. However, they observed little difference in liver-related death or liver transplantation between heavy drinkers vs non-drinkers (10% vs 6%).

“In an analysis of data from the DILIN, we found anabolic steroids to be the most common cause of DILI in individuals who are heavy consumers of alcohol,” the researchers concluded. “Compared to non-drinkers, DILI was not associated with a greater proportion of liver-related deaths or liver transplantation in heavy drinkers.”

—Christina Vogt

Reference:

Dakhoul L, Ghabril M, Gu J, Navarro V, Chalasani N, Serrano J; United States Drug Induced Liver Injury Network. Heavy consumption of alcohol is not associated with worse outcomes in patients with idiosyncratic drug-induced liver injury compared to non-drinkers [in press]. Clin Gastroenterol Hepatol. Accessed January 10, 2018.