Drug-induced liver injury: diagnosis of exclusion

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Abstract

Drug-induced liver injury (DILI) is a relevant issue in clinical practice and is still a diagnosis of exclusion. Despite the low incidence in the general population, DILI is the cause of most cases of acute hepatic injury and has a mortality rate of up to 50%. Despite many reports in the medical literature about the DILI mechanisms, a clear causal relationship between them, drugs, and risk factors has not been established. Current clinical practice is based on a combination of a thorough study of a history of risk factors, the timing of drug and dietary supplements' administration, and the analysis of laboratory and instrumental tests. It aligns with the international criteria of the Rousell Uclaf Causality Assessment Method (RUCAM), which is considered one of the main diagnostic algorithms for DILI. The article addresses current DILI classification, risk factors, diagnostic algorithms, causalities, clinical evaluation, promising liver function biomarkers, and specific treatment.

About the authors

Igor V. Maev

Yevdokimov Moscow State University of Medicine and Dentistry

Email: polunina@mail.ru
ORCID iD: 0000-0001-6114-564X

акад. РАН, д-р мед. наук, проф., зав. каф. пропедевтики внутренних болезней и гастроэнтерологии

Russian Federation, Moscow

Tatiana E. Polunina

Yevdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: polunina@mail.ru
ORCID iD: 0000-0003-2182-8379

д-р мед. наук, проф., проф. каф. пропедевтики внутренних болезней и гастроэнтерологии

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Classification of drug-induced liver injury with the most typical hepatotoxic drugs.

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3. Fig. 2. The mechanism of injury due to the direct action of drugs or their metabolites on the liver and immune-mediated drug-induced liver injury. Adapted from [7].

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4. Fig. 3. Diagnosis of drug-induced liver injury.

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