Objective  To analyze the clinical characteristics of drug-induced liver injury (DILI) caused by different drug categories, and to investigate factors influencing DILI prognosis.

Methods  Medical records of DILI patients diagnosed in our hospital from January 1, 2019 to December 31, 2023 were retrospectively collected. Clinical characteristics of DILI induced by different drug categories were analyzed. Multivariate Logistic regression was employed to identify prognostic factors of DILI.

Results  A total of 347 DILI patients were included. The predominant DILI pattern was hepatocellular injury (67.15%), followed by cholestatic (20.46%) and mixed types (12.39%). The top three causative drug categories were traditional Chinese medicine (25.34%), antineoplastic drugs (24.15%) and anti-infective agents (21.26%). Regarding prognosis outcomes, 7 cases (2.02%) achieved complete recovery, 269 cases (77.52%) showed improvement, and 71 cases (20.46%) demonstrated no improvement. Significant differences were observed among prognosis groups in age, gender, alanine aminotransferase level, aspartate transaminase level, alkaline phosphatase levels, DILI patterns, number of combined hepatoprotective drugs used, and causative drug categories (P<0.05). Multivariate analysis revealed that cholestatic type [OR=0.237, 95%CI (0.083, 0.673), P=0.007] and combination therapy with >2 hepatoprotective drugs [OR=0.551, 95%CI (0.295, 0.998), P=0.018] were independent risk factors for prognosis.

Conclusion  The number of hepatoprotective drugs used in combination and DILI patterns may serve as potential indicators for prognosis evaluation. Particular attention should be paid to the hepatotoxicity of traditional Chinese medicine, antineoplastic agents, and anti-infective drugs. Rational drug selection is essential for improving DILI prevention and treatment.

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