PWE-086 Temporal change and phenotypic pattern of liver function tests can distinguish ischaemic hepatitis from drug induced liver injury– a large 6 year retrospective cohort analysis

Introduction Drug induced liver injury (DILI) can be difficult to differentiate from ischaemic hepatitis (IH). We hypothesised that the temporal pattern in the change of bilirubin and alanine transaminase (ALT) may help distinguish those patients with IH compared to DILI. Method Retrospective single centre analysis of biochemical data from 68 sequential patients with IH over 84 months (mean age 65 ±SEM 1.1 year, 63% male) and 66 patients with DILI (67 ±SEM 1.9 year; 46% male) over a 79 month period. Patients were identified from the hospital biochemistry and outpatient Jaundice Hotline (JHL) databases. The diagnosis of DILI based on the use of established causality analysis criteria. IH cases were defined as patients with an ALT level u003e1000 iu/L with a clinical ischaemic event and exclusion of those with elevated paracetamol levels, autoimmune or viral hepatitis and DILI on clinical review. Comparative ALT and bilirubin data between the two groups was analysed from 14 days prior to and 35 days after presentation (day 0) using unpaired t tests for unequal variance Results The IH cohort had a higher rise in index ALT (1321 ±SEM166 iu/l) compared to those with DILI (319±32; p Conclusion These data support the hypothesis that patients with ischaemic hepatitis demonstrate a greater rise in ALT following an ischaemic insult and subsequently have a relatively short recovery phase compared to those with DILI. Conversely, patients with severe DILI exhibit a high index bilirubin. These presenting biochemical features and temporal changes may help distinguish DILI from IH. Disclosure of Interest None Declared