CSH guidelines for the diagnosis and treatment of drug-induced liver injury

Abstract

Drug-induced liver injury (DILI) is an important clinical problem, which has received more attention in recent decades. It can be induced by small chemical molecules, biological agents, traditional Chinese medicines (TCM), natural medicines (NM), health products (HP), and dietary supplements (DS). Idiosyncratic DILI is far more common than intrinsic DILI clinically and can be classified into hepatocellular injury, cholestatic injury, hepatocellular-cholestatic mixed injury, and vascular injury based on the types of injured target cells. The CSH guidelines summarized the epidemiology, pathogenesis, pathology, and clinical manifestation and gives 16 evidence-based recommendations on diagnosis, differential diagnosis, treatment, and prevention of DILI.

Prolonged interval of total bilirubin decline is an early independent predictive factor of chronic persistent drug‐induced liver injury

“…Through statistical analysis, we found that the older the patients were, the more likely they were to develop cholestasis injury. This might be associated with decreasing capability of liver detoxification and excretion, and more medication consumed along with aging, although the underlying mechanism clearly needs to be investigated in future studies . We followed the definition of chronic DILI of the American College of Gastroenterology Clinical Guideline, if LFTs did not return to normal within 6 months after drug withdrawal, regardless of the types of liver injury.…”

“…Additionally, two hepatologists independently evaluated the causality using the Roussel Uclaf Causality Assessment Method (RUCAM) score. The patients in the present study must have had a RUCAM score ≥3 . If there was a discrepancy related to the RUCAM score, two hepatologists discussed the matter combined with pathological information until an agreement was reached.…”

“…The pattern of liver injury was classified according to the Council of International organizations of Medical Sciences, which use ALT and alkaline phosphatase (ALP) activity at DILI onset, expressed as times of the upper limit of normality, to determine the ratio (R) of ALT/ALP . Therefore, three patterns were defined, including hepatocellular when R ≥5, cholestatic when R ≤2, and mixed when 2 < R < 5 . The severity of diseases was categorized as one of four degrees (mild, moderate, severe, and fatal/transplant), as described by an international DILI Expert Working Group …”

“…Therefore, three patterns were defined, including hepatocellular when R ≥5, cholestatic when R ≤2, and mixed when 2 < R < 5 . The severity of diseases was categorized as one of four degrees (mild, moderate, severe, and fatal/transplant), as described by an international DILI Expert Working Group …”

Clinicopathological features of Bu Gu Zhi‐induced liver injury, a long‐term follow‐up cohort study

“…The Roussel Uclaf Causality Assessment Method (RUCAM) score was used to evaluate causality between BGZ administration and liver injury. RUCAM scores were grouped into likelihood levels as ‘excluded’ (0), ‘unlikely’ (1‐2), ‘possible’ (3‐5), ‘probable’ (6‐8) and ‘highly probable’ (≥9) …”