[RUCAM scale-based diagnosis, clinical features and prognosis of 140 cases of drug-induced liver injury].

OBJECTIVE: To analyze the etiology, clinical features and prognosis of liver injuries caused by different drugs. METHODS: The types of suspected drugs related to liver injury, clinical manifestations, liver biochemical parameters, clinical outcomes and other associated data were retrospectively assessed for 140 patients with drug-induced liver injury (DILI). The Roussel Uclaf Causality Assessment Method (RUCAM) was used to assess the causality between drugs and liver injury. RESULTS: The most prevalent agents inducing DILI were Chinese traditional drugs (62.1%), followed by antipyretic analgesic drugs (10%) and antibiotics (5%). The ratio of male to female patients in the study cohort was 1:1.69, with 71 of the total patients (50.7%) being between the ages of 40 and 60 years-old. The RUCAM scale was not less than 3 points for any of the patients.In general, the clinical manifestations and biochemical results were not specific. The percentages of hepatocellular injury type, cholestatic injury type and mixed injury type were 51.4%, 30.7% and 17.9% respectively. The median age of patients with cholestatic liver injury was 55.6 years, which was older than that of patients with hepatocellular injury (47.1 years) or mixed injury (49.9 years). CONCLUSION: Although antipyretic analgesics and antibiotics are considered as common drugs that can induce DILI, Chinese traditional drugs have emerged as another important group of liver injurious agents. Cholestatic DILI was found to occur more often in elderly patients than in younger patients.

Validation of the revised electronic version of RUCAM for diagnosis of DILI in Chinese patients.

BACKGROUND AIMS: The Revised Electronic Causality Assessment Method (RECAM), a computerized update of the Roussel Uclaf Causality Assessment Methodology (RUCAM), was recently proposed. In this study, we validated and compared the utility of the RECAM and RUCAM in Chinese patients with a single conventional or herbal agent-induced liver injury. METHODS: In this retrospective multicenter cohort of well-established DILI and non-DILI patients from 5 centers in China, the diagnostic performance of the RUCAM and RECAM was compared by AUC analysis. The consistency was evaluated by weighted kappa. The major causes of discrepancy were explored. RESULTS: A total of 481 DILI and 100 non-DILI patients were included. In total, 62.6% of the DILI cases were induced by conventional agents, and 37.4% were induced by herbs. The RECAM had relatively higher AUC than RUCAM for overall [0.947 (0.926-0.964) vs. 0.867 (0.836-0.893), p=0.0016], conventional agents [0.923 (0.890-0.949) vs. 0.819 (0.775-0.858), p=0.0185], and herbs [0.972 (0.941-0.989) vs.0.911 (0.866-0.944), p=0.0199]. Latency, scores associated with hepatitis B, and hepatotoxicity information of the insulting drugs were the 3 main causes for the inconsistency between RECAM and RUCAM scores. CONCLUSIONS: The RECAM had relatively better diagnostic performance than RUCAM, with a higher AUC for Chinese DILI patients. Timely updates of the LiverTox category and refinement of serum markers to exclude hepatitis B activity would further improve the applicability of RECAM in areas where the use of herbs and resolution of past HBV infections are common.

Enhanced removal of bisphenol-AF onto chitosan-modified zeolite by sodium cholate in aqueous solutions.

The removal of bisphenol-AF (BPAF) from aqueous solutions onto chitosan-modified zeolite (Ch-Z) in the absence and presence of sodium cholate (NaC) was investigated. It was found that NaC significantly increased the adsorption capacity of Ch-Z for BPAF. At an initial concentration of 100 µmol/L, the removal of BPAF by adsorption onto Ch-Z with NaC was more than ninefold higher than without NaC, and the maximum removal was achieved at a Ch-Z dosage of 1g/L with a NaC concentration of 1.68 mmol/L. Besides, batch studies were performed to evaluate the effects of various experimental parameters on the removal of BPAF. Kinetic studies and adsorption isotherms indicated that the adsorption process of BPAF onto Ch-Z with NaC could be expressed by a pseudo second-order model and the Freundlich isotherm model, respectively. For the enhanced removal, an interaction mechanism was proposed involving the co-effect of BPAF and NaC adsorbed onto Ch-Z.