Assessment of Serious Acute and Chronic Idiosyncratic Drug-Induced Liver Injury in Clinical Practice

Fernando Bessone; Mercedes Robles-Diaz; Nelia Hernandez; Inmaculada Medina-Caliz; M. Isabel Lucena; Raul J. Andrade

doi:10.1055/s-0039-1685519

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2019; 39(03): 381-394
DOI: 10.1055/s-0039-1685519

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Assessment of Serious Acute and Chronic Idiosyncratic Drug-Induced Liver Injury in Clinical Practice

Fernando Bessone^*

¹Hospital Provincial del Centenario, University of Rosario School of Medicine, Rosario, Argentina

,

Mercedes Robles-Diaz^*

²Unidad de Gestión Clínica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Hospital Universitario Virgen de la Victoria, Málaga, Spain

³Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

,

Nelia Hernandez

⁴Facultad de Medicina, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay

,

Inmaculada Medina-Caliz

⁵Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Hospital Universitario Virgen de la Victoria, Málaga, Spain

,

M. Isabel Lucena^#

³Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

⁵Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Hospital Universitario Virgen de la Victoria, Málaga, Spain

⁶Unidad Investigación Clínica y Ensayos Clínicos (UICEC)-IBIMA, Plataforma Spanish Clinical Research Network (SCReN), Málaga, Spain

,

Raul J. Andrade^#

²Unidad de Gestión Clínica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Hospital Universitario Virgen de la Victoria, Málaga, Spain

³Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

› Author Affiliations

Abstract

Drug-induced liver injury (DILI) is the leading cause of acute liver failure (ALF) in developed countries. The extremely variable phenotype of DILI, both in presentation and in severity, is one of the distinctive characteristics of the disease and one of the major challenges that hepatologists face when assessing hepatotoxicity cases. A new Hy's law that more accurately predicts the risk of ALF related to DILI has been proposed and validated. Other prognostic scoring algorithms for the early identification of DILI patients who may go on to develop ALF have been developed as it is of most clinical relevance to stratify patients for closer monitoring. Recent data indicate that acute DILI often presents a more prolonged resolution or evolves into chronicity at a higher frequency than other forms of acute liver injury. Risk factors for chronicity, specific phenotypes, and histological features are discussed in this study. Biomarkers to predict DILI outcome are in need.

Keywords

hepatotoxicity - acute liver failure - chronic DILI - risk factors - histopathology

Full Text

References

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