S1183 Drug Induced Liver Injury Related to Recreational Drugs Is Associated With Higher Mortality and Increased ICU Admission in a Multi-Ethnic United States Population

INTRODUCTION: Drug Induced Liver Injury (DILI) is a leading cause of acute liver failure in the United States. While it is known that Drugs of Abuse (DoA) can cause acute liver injury, the patterns of DILI and outcomes associated with DoA use are not well established. The aim of this investigation was to compare DILI related to DoA with DILI related to all other etiologies in terms of mortality, ICU admission, and length of stay. METHODS: Cases of suspected DILI from 2007 to 2019 were extracted from a multi-ethnic cohort of patients from Miami that were reported to the Florida Poison Information Center. Retrospective electronic chart review was conducted on cases seen at two large Miami-based academic centers. Chi-Squared analysis was utilized to assess DILI and clinical outcomes, and adjusted length of stay (LOS) was estimated by accounting for age and gender. RESULTS: In this cohort, 20 cases of DILI related to DoA, as seen in Table 1, were identified, compared to 70 cases related to all other etiologies. This cohort was comprised of a majority of males (55.6%) aged < 50 years (78.9%), and were Hispanic (42.2%), White (28.9%) and Black (28.9%). There were no significant differences in the mean peak AST, ALT, ALP, T Bili, or INR among the two groups (Table 2). Rates of ICU admission were significantly higher in the DoA group when compared to all other etiologies (80.0% vs. 50.0%, χ2(1, N = 90) = 5.70, P = 0.017). Mortality was also shown to be significantly elevated in the DoA group (35.0% vs. 11.4%, χ2(1, N = 90) = 6.22, P = 0.013). Furthermore, patients with DILI related to DoA had a longer mean hospital LOS, 14.25 days (16.61) vs. 9.17 days (7.91), which approached significance (P = 0.058). Multivariable regression analysis revealed predictors for longer hospital LOS were admission to the ICU (P = 0.026), gender (P = 0.049), higher peak AST (P = 0.001), higher peak ALP (P < 0.001), and DoA use (P = 0.007). CONCLUSION: Poorer outcomes were noted among patients with DILI related to Drugs of Abuse when compared to DILI related to all other etiologies. Though biochemical disease severity did not vary significantly between the two groups, DILI related to Drugs of Abuse was significantly associated with both ICU admission and mortality. Moreover, admission to the ICU, higher peak AST and ALP, female gender, and use of Drugs of Abuse were all associated with a longer length of stay. Larger studies are needed to validate our findings.Table 1.: Detailed breakdown of the Drugs of Abuse category, with percentages representing percent of the entire cohort (n = 90)Table 2.: Baseline biochemical characteristics, age and length of stay in the Drugs of Abuse group vs. the non-Drugs of Abuse group