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Semin Liver Dis 2009; 29(4): 357-363
DOI: 10.1055/s-0029-1240004
© Thieme Medical Publishers

The Natural History of Drug-Induced Liver Injury

Einar Björnsson1
  • 1Section of Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Publication History

Publication Date:
13 October 2009 (online)

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ABSTRACT

The development of acute hepatocellular injury with jaundice in patients with drug-induced liver injury (DILI) has been associated with a case-fatality rate of 10 to 50%, depending on the drug involved. This observation, called “Hy's rule,” is frequently used by regulatory agencies in assessing the hepatotoxic potential of drugs being tested in clinical trials. Registry studies from Sweden, Spain, and the United States have confirmed the validity of Hy's rule by demonstrating a 9 to 12% mortality rate in consecutive DILI patients. In patients with suspected DILI, the causative agent should be immediately discontinued, and hospitalized patients with severe coagulopathy or encephalopathy should be referred for potential liver transplantation. Recent studies have shown that DILI can infrequently evolve into chronic liver injury including cirrhosis and even liver-related morbidity and mortality in a minority of patients.

KEYWORDS

Liver transplantation - Hy's rule - acute liver failure - hepatic necrosis - eosinophilia

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Einar BjörnssonM.D. Ph.D. 

Professor of Gastroenterology and Hepatology, Department of Internal Medicine

Sahlgrenska University Hospital, Med pol II, SE-413 45 Gothenburg, Sweden

Email: einar.bjornsson@medic.gu.se

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