S2791 Examining Prognostic Factors in Patients With Acute Liver Failure Secondary to DRESS Syndrome

Introduction: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe medication reaction characterized by eosinophilia, rash, and organ dysfunction. Although uncommon, liver injury secondary to DRESS can be severe, with acute liver failure (ALF) secondary to DRESS comprising a sizable number of transplants. However, little is known about prognostic factors that impact recovery in patients with DRESS and ALF. Methods: A literature search using PubMed and Google Scholar was conducted for case reports of adult DRESS complicated by ALF and 43 patients were chosen. Patients were separated into recovery or non-recovery (transplant/death) groups. Laboratory values, demographics, and management were analyzed. Two tailed T-testing and Incidence rate ratios were used to determine significance of differences between groups (P < 0.05). Results: Standard deviations indicated high data variability. There were no significant differences between characteristics or initial lab values between groups (P > 0.05). Non-recovery patients had significantly higher rates of multiorgan failure (P < 0.05) but not viral reactivation. Seven patients received transplants and 4 were successful. The most common secondary organ failure was renal failure with no difference between groups. Most common causes of death included multiorgan failure, sepsis, and cardiac arrest. No differences in treatments including steroid use were observed between groups. Conclusion: No significant difference in laboratory values or characteristics were seen suggesting that prognostication in this patient population is challenging. No difference was seen in steroid usage which is suggesting this may not impact mortality or need for transplant. No difference was seen in viral reactivation suggesting that this is not a reliable prognostic factor. Similar renal failure rates between groups indicate a relationship with liver injury previously reported in DRESS.1 Only multiorgan failure significantly impacted recovery suggesting more progressive disease leading to poor outcomes in the non-recovery group for unknown reasons. We continue to have no prognostication tool for ALF in DRESS likely due to rarity resulting in limited power and coexisting confounding variables. However, this raises a need for close monitoring of clinical decompensation and future studies on this topic. Reference 1. Lee WM, Squires RH, Jr, Nyberg SL et al. Acute liver failure: Summary of a workshop. Hepatology. 2008;47:1401–1415. doi: 10.1002/hep.22177.