The DOI matches its Crossref record; 21 of the 21 references it cites were found in a registry or an index; 2 of the 12 sources its claims cite were checked for support.
A revised electronic version of RUCAM for the diagnosis of DILI
Open accessAbstract
Background and Aims: Roussel Uclaf Causality Assessment Method (RUCAM) for DILI has been hindered by subjectivity and poor reliability. We sought to improve the RUCAM using data from the Drug‐Induced Liver Injury Network (DILIN) and the Spanish DILI Registry, published literature, and iterative computer modeling. Approach and Results: RUCAM criteria were updated, clarified, and computerized. We removed criteria 3 (risk factors) for lack of added value and criteria 4 because we felt it more useful to assess each drug separately. Criteria 6 (drug‐specific risk) was anchored to LiverTox likelihood scores. Iterative testing in subsets of 50–100 single‐agent, nonherbal cases from both registries was done to optimize performance. We used classification tree analysis to establish diagnostic cutoffs for this revised electronic causality assessment method (RECAM) and compared RECAM with RUCAM for correlation with expert opinion diagnostic categories in 194 DILI cases (98 DILIN, 96 Spanish DILI). Area under receiver operator curves for identifying at least probable DILI were the same at 0.89 for RECAM and RUCAM. However, RECAM diagnostic categories have better observed overall agreement with expert opinion (0.62 vs. 0.56 weighted kappa, p = 0.14), and had better sensitivity to detect extreme diagnostic categories (73 vs. 54 for highly likely or high probable, p = 0.02; 65 vs. 48 for unlikely/excluded, p = 0.08) than RUCAM diagnostic categories. Conclusions: RECAM is an evidence‐based update that is at least as capable as RUCAM in diagnosing DILI compared with expert opinion but is better than RUCAM at the diagnostic extremes. RECAM’s increased objectivity and clarity will improve precision, reliability, and standardization of DILI diagnosis, but further refinement and validation in other cohorts are needed.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
RECAM is a revised, computerized version of RUCAM for diagnosing drug-induced liver injury (DILI), developed with data from the US DILIN and Spanish DILI Registry. In 194 DILI cases, RECAM and RUCAM had the same AUC of 0.89 for identifying at least probable DILI, but RECAM showed better agreement with expert opinion and better sensitivity at diagnostic extremes.
Key findings
- RECAM reduced the original 7 RUCAM criteria to 5 domains, removed risk factors and concomitant-drug criteria, anchored drug-specific risk to LiverTox® likelihood scores, and added automatic warnings/stops for alternate diagnoses or inconsistent timing.
- For identifying at least probable DILI, RECAM and RUCAM had the same AUC of 0.89; overall percent agreement with expert opinion was 62% for RECAM vs. 59% for RUCAM (p=0.44).
- Weighted kappa agreement with expert opinion was 0.62 for RECAM vs. 0.56 for RUCAM (p=0.14 in the abstract; p=0.16 in Results).
- RECAM had better sensitivity for extreme categories: 73 vs. 54 for highly likely/high probable (p=0.02) and 65 vs. 48 for unlikely/excluded (p=0.08).
Methods
- RECAM was developed iteratively from 2015 onward through 5 stages and 12 versions, using DILIN and Spanish DILI Registry cases, published literature, expert opinion, and computer modeling; development was restricted to single-agent, non-herbal/dietary supplement cases.
- Final testing used 98 DILIN and 96 Spanish DILI Registry single-agent, non-HDS cases; DILIN cases were stratified equally across its 5 likelihood categories, and cases were categorized by R-value as hepatocellular, cholestatic, or mixed.
- RECAM scoring was semi-automated via computer extraction and scoring; classification tree analysis established diagnostic cut-offs, and performance was compared with RUCAM using AUCs, Spearman’s Rho, percent agreement, weighted kappa, sensitivity, and specificity against expert opinion.
Limitations
- The paper states RECAM was developed in US and Spanish cohorts, so performance in other regions—particularly Asia—is unknown; both registries have minimum liver enzyme and bilirubin enrollment criteria, so performance in less severe injuries is unclear.
- The paper states RECAM needs testing in a broader group of clinicians including non-hepatologists, is limited to single-agent medication cases, is not designed or tested for herbal and dietary supplement liver injury, and increases data entry compared with RUCAM.
- The paper states some clinical judgment remains necessary, such as judging whether a biliary stricture is clinically insignificant and scoring drugs not included in LiverTox®; it also notes an AUC ceiling of 0.85–0.89 because algorithms cannot capture factors such as delayed care, death/transplant, or chronic DILI, and concludes RECAM is not a standalone diagnostic tool.
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Claims the paper makes
24 Own interpretation · 13 Own result · 4 Not checked yet · 4 No basis given · 3 Own method · 1 Partly supported · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Also, both registries have minimum enrollment criteria for liver enzyme and bilirubin elevation, so it is unclear how the RECAM may perform in less severe injuries.8, 10”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
What the sources say
- Supportedcites [8] Fontana RJ, Watkins PB, Bonkovsky HL, Drug-Induced Liver Injury Network (DILIN) prospective study: rationale, design and conduct. Drug Saf 2009; 32: 55– 68. 19132805 PMC3637941 source
The Methods, under “Inclusion and Exclusion Criteria,” specify minimum liver-enzyme thresholds and an alternative bilirubin threshold for enrollment in the DILIN registry. This source supports the DILIN portion of the two-registry statement; the uncertainty about RECAM performance is the citing authors’ inference, not a finding attributed to this 2009 paper. (LLM, conf=0.88)
- Partly supportedcites [10] Stephens C, Robles-Diaz M, Medina-Caliz I, Comprehensive analysis and insights gained from long-term experience of the Spanish DILI registry. J Hepatol 2021. 33539847 sourceExperimental — accuracy not yet measured
The Design section states that the Spanish DILI Registry uses biochemical criteria involving minimum ALT or ALP elevations, with bilirubin elevation required for one qualifying combination. It does not establish the other registry’s enrollment criteria or assess how RECAM performs in less severe injuries. (LLM, conf=0.85)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In a stratified analysis by cohort the RECAM and the RUCAM scale AUCs showed better performance in Spanish DILI cases compared to DILIN cases.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Results > RECAM and RUCAM Performance:
plaincorrelationaln = 96- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“had better sensitivity to detect extreme diagnostic categories (73 vs. 54 for highly likely or high probable, p=0.02; 65 vs. 48 for unlikely/excluded, p = 0.08) than RUCAM diagnostic categories.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Abstract > Approach and Results:
plaincorrelationaln = 194 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“These stops and penalizations led to downward distribution of scores in both registries, particularly unlikely or excluded cases.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“had better sensitivity to detect extreme diagnostic categories (73 vs. 54 for highly likely or high probable, p=0.02; 65 vs. 48 for unlikely/excluded, p = 0.08) than RUCAM diagnostic categories.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Abstract > Approach and Results:
plaincorrelationaln = 194 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“RECAM and RUCAM performed similarly well across all three cut-offs (AUC > 0.8 in all likelihood categories).”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Results > RECAM and RUCAM Performance:
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Area under receiver operator curves (AUC) for identifying at least probable DILI were the same at 0.89 for RECAM and RUCAM.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Abstract > Approach and Results:
plainn = 194- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Both RECAM and RUCAM had similarly high statistical correlation between the resulting scores and the four ordinal diagnostic categories provided by experts (Spearman Rho 0.85, p<0.001 and 0.87, p<0.001, respectively).”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Results > RECAM and RUCAM Performance:
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Contrary to expectations, distinction between hepatocellular and cholestatic/mixed injuries was not necessary for latency and dechallenge scoring.”
- Also stated in: § RUCAM Modifications for RECAM Development: · plain
“Based on analysis of DILIN and Spanish Registry data, dechallenge timing is similar for hepatocellular and cholestatic/mixed cases in terms of causality.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Methods > Process overview:
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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- Also stated in: § RUCAM Modifications for RECAM Development: · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Both scales showed great and similar specificity along likelihood categories, except for probable cases, where the RECAM scale showed better performance (Table 4).”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Results > RECAM and RUCAM Performance:
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, RECAM diagnostic categories have better observed overall agreement with expert opinion (0.62 vs. 0.56 weighted kappa, p = 0.14)”
- Also stated in: § RECAM and RUCAM Performance: · plain
“By Cohen’s weighted Kappa coefficient, RECAM had better observed overall agreement compared to RUCAM (0.62 vs 0.56), although statistical significance was not reached (p=0.16) (Table 4).”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Abstract > Approach and Results:
plaincorrelationaln = 194- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § RECAM and RUCAM Performance: · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For the standard RUCAM and new RECAM, these 3 variables did not contribute significantly to logistic regression modeling to diagnose at least probable DILIN cases (age, odds ratio [OR] 1.12 (95% CI 0.71–1.76), p = 0.62; alcohol and pregnancy, OR 0.90 (0.47–1.73), p = 0.75).”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Results > RUCAM Modifications for RECAM Development:
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, the impact of histology on RECAM performance was minimal.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“RECAM’s remarkably high AUCs in the Spanish DILI Registry (Supplemental Table 3) provide some criterion validity as the Spanish experts rely more on RUCAM for their diagnostic categories.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Spanish experts rely more on RUCAM for their diagnostic categories.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The comparable AUCs for RUCAM and RECAM also confirms that the risk factors of age ≥55, alcohol intake, and pregnancy do not add value to the diagnosis of DILI (Supplemental Case 1) and suggests that the 5-domain RECAM without differentiation between hepatocellular and cholestatic/mixed injury is adequate.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“RECAM’s increased objectivity and clarity will improve precision, reliability and standardization of DILI diagnosis but further refinement and validation in other cohorts are needed.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Abstract > Conclusions:
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“RECAM is an evidenced based update that is at least as capable as RUCAM in diagnosing DILI compared to expert opinion but is better than RUCAM at the diagnostic extremes.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Abstract > Conclusions:
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Inability to capture such factors led to an AUC ceiling of 0.85–0.89 for both the RECAM and RUCAM when compared to expert opinion.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The comparable AUCs for RUCAM and RECAM also confirms that the risk factors of age ≥55, alcohol intake, and pregnancy do not add value to the diagnosis of DILI (Supplemental Case 1) and suggests that the 5-domain RECAM without differentiation between hepatocellular and cholestatic/mixed injury is adequate.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“RECAM is an evidenced based update that is at least as capable as RUCAM in diagnosing DILI compared to expert opinion but is better than RUCAM at the diagnostic extremes.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Abstract > Conclusions:
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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In the paper
“Even when data clearly diagnose acute viral hepatitis or autoimmune hepatitis by simplified autoimmune hepatitis score 16 points are still given for latency, dechallenge or underlying hepatotoxicity risk of the drug.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
What the sources say
- Not checked yetcites [16] Hennes EM, Zeniya M, Czaja AJ, Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology 2008; 48: 169– 76. 18537184 source
boosteddirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The high performance suggests enough retained similarity to support RECAM’s application to that Registry and others currently based on RUCAM.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This may have led to better identification of highly likely or high probable cases (Supplemental Case 3).”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedgedconditionalSingle case ·- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It will likely have better inter- and intra-rater reliability due to computerized data entry and minimized subjective opinion.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Gradation of cut-offs was increased for latency times based on latencies in DILIN cases, expert opinion and iterative testing of cases.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These changes also may have helped RECAM better identify more of the highly probable cases.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 19
- Probably not a substantial claim. 8
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For the Spanish cases, the RECAM AUCs ranged from 0.95 (at least probable cases) to 0.99 (at least possible cases), while in DILIN cases AUCs ranged from 0.80 (at least possible cases) to 0.86 (at least probable cases) (Supplemental Table 3).”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Results > RECAM and RUCAM Performance:
plaincorrelationaln = 96- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In both registries, liver biopsy was often not obtained, and pathognomonic signs of DILI or alternate diagnosis were even less common.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The overall percent agreements between the RECAM and RUCAM scales with expert’s opinion were 62% and 59%, respectively (p=0.44).”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Results > RECAM and RUCAM Performance:
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“By using classification tree approach, we estimated RECAM diagnostic cut-offs of ≥8 for highly likely/high probable, 7 to 4 for probable, 3 to −3 for possible, and, ≤ −4, , unlikely/excluded DILI, respectively.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Results > RECAM and RUCAM Performance:
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These differences were likely due to a wider scoring range for latency and dechallenge that was developed from case data and the heavier penalization for lack of data or data indicating a non-DILI diagnosis.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“RECAM’s separation of diagnostic categories, especially unlikely and excluded cases, was also better in Spanish cases (Supplemental Figure 1c) because the DILIN often excludes cases that have definitive competing diagnoses arise during screening, while the Spanish group retains such cases for data analyses.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
- Rests on an assumption: DILIN often excludes cases that have definitive competing diagnoses arise during screening, while the Spanish group retains such cases for data analyses.
None of the sources cited for this claim have been checked yet.
In the paper
“It is the most widely used and accepted DILI diagnostic tool.2, 3”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Introduction
What the sources say
- Not checked — no full text of the sourcecites [2] Chalasani NP, Maddur H, Russo MW, ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury. Am J Gastroenterol 2021; 116: 878– 898. 33929376 source
- Not checked yetcites [3] European Association for the Study of the Liver. Electronic address eee, Clinical Practice Guideline Panel C, Panel m, et al. EASL Clinical Practice Guidelines: Drug-induced liver injury. J Hepatol 2019; 70: 1222– 1261. 30926241
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“The RECAM is also not designed nor tested for HDS liver injury which is increasingly reported.20–22”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
What the sources say
- Not checked yetcites [20] Navarro VJ, Barnhart H, Bonkovsky HL, Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. Hepatology 2014; 60: 1399– 408. 25043597 PMC4293199 source
- Not checked yetcites [21] Medina-Caliz I, Garcia-Cortes M, Gonzalez-Jimenez A, Herbal and Dietary Supplement-Induced Liver Injuries in the Spanish DILI Registry. Clin Gastroenterol Hepatol 2018; 16: 14951502. 29307848 source
- Not checked yetcites [22] Shen T, Liu Y, Shang J, Incidence and Etiology of Drug-Induced Liver Injury in Mainland China. Gastroenterology 2019; 156: 2230– 2241 e11. 30742832 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“RECAM also offers an automated scoring with less subjective input which should lead to better reliability.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Roussel Uclaf Causality Assessment Method (RUCAM) for drug-induced liver injury (DILI) has been hindered by subjectivity and poor reliability.”
- Also stated in: § Introduction · plain
“Since 1993, there have been three major problems with RUCAM: (1) unclear operating instructions and subjectivity leading to poor reliability and usability, (2) unclear validity due to lack of an accepted gold standard and (3) domain criteria that are not evidence-based.6”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Abstract > Background and Aims:
What the sources say
- Not checked yetcites [4] Kaplowitz N Causality assessment versus guilt-by-association in drug hepatotoxicity. Hepatology 2001; 33: 308– 10. 11124850
- Not matchedcites [5] Hayashi PH. Causality assessment in drug-induced liver injury. Semin Liver Dis 2009; 29: 348– 56. 19826968
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [6] Garcia-Cortes M, Stephens C, Lucena MI, Causality assessment methods in drug induced liver injury: strengths and weaknesses. J Hepatol 2011; 55: 683– 691. 21349301 source
- Not checked yetcites [7] Danan G, Teschke R. RUCAM in Drug and Herb Induced Liver Injury: The Update. Int J Mol Sci 2015; 17. PMC4730261 26712744 source
Checked before — its earlier verdict is held back until a new check runs.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Introduction · plain
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It was developed in US and Spanish cohorts, so we do not know how it may perform in other regions, particularly Asia.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“It is limited to single agent medication cases leaving the user to score each medication individually in multi-drug cases.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The elimination of alternate diagnoses only prevents a loss of points because ruling out competing etiologies does not directly support a DILI diagnose in the same way as latency and dechallenge do.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Rests on an assumption: DILI is a diagnosis of exclusion where competing causes should only hurt the case.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“RECAM has better sensitivities at the extreme diagnostic categories and tends to have better overall agreement with expert opinion.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In the RUCAM, an alternate diagnosis or other data could rule out DILI, but the case would still gain points in other criteria (Supplemental Cases 2 and 3).”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The electronic, automated platform that is available for all to use on the Internet should also help with efforts at harmonization and standardization in DILI research.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Accuracy of 80–90% for identifying at least probable DILI compared to expert opinion is high, but not high enough to make the RECAM a standalone diagnostic tool.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Domains are based on data from well-vetted cases that were often followed for a minimum of 6 months.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The RUCAM assigns a single point for any latency from 5 to 90 days after drug start, while the RECAM has 3 different scores within the span of 2 to 90 days regardless the type of liver injury.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“RECAM’s AUC of 0.89 and better ability to separate diagnostic categories (Figure 1) provide a useful framework for such decision making.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It cuts unnecessary variables that were not diagnostically helpful and is less subjective.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Indeed, the RECAM provides an opportunity to conduct causality assessment using standardized, quantitative and categorical data fields which should lead to improved case identification and possibly earlier diagnosis.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The improved stratification may better classify cases for genetic (e.g., HLA) and other DILI biomarker development, and increased consistency will make it a better teaching tool.”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper relies on this without support.
Spanish experts rely more on RUCAM for their diagnostic categories.
“as the Spanish experts rely more on RUCAM for their diagnostic categories.”
The paper relies on this without support.
DILIN often excludes cases that have definitive competing diagnoses arise during screening, while the Spanish group retains such cases for data analyses.
“because the DILIN often excludes cases that have definitive competing diagnoses arise during screening, while the Spanish group retains such cases for data analyses.”
The paper relies on this without support.
A positive prospective rechallenge is highly indicative of DILI.
“a positive prospective rechallenge is highly indicative of DILI and awarded more points than any other component in the RECAM (+6).”
The paper relies on this without support.
DILI is a diagnosis of exclusion where competing causes should only hurt the case.
“because DILI is a diagnosis of exclusion where competing causes should only hurt the case.”
The paper relies on this without support.
Liver histology is uncommonly diagnostic of DILI.
“Liver histology is uncommonly diagnostic of DILI, so points awarded were limited.”
The paper relies on this without support.
The heterogeneity of DILI phenotypes makes it difficult to develop a single, easy-to-use diagnostic tool for all medications.
“The heterogeneity of DILI phenotypes makes it difficult to develop a single, easy-to-use diagnostic tool for all medications.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“This semi‐automated, computerized platform and validated scoring system covers a dynamic range of −6 to +20 points.”
From Methods for causality assessment of idiosyncratic drug‐induced liver injury (2025) · cites this paper as [37]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Contrary to expectations, the distinction between hepatocellular and cholestatic/mixed injury was not necessary for latency (both from drug start & drug stop) and dechallenge scoring.”
From Methods for causality assessment of idiosyncratic drug‐induced liver injury (2025) · cites this paper as [37]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“RECAM seems to lead to improved case identification, earlier diagnosis, and medical management of DILI cases.”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [64]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“This method was redesigned using data from DILI cases due to single drugs included in these prospective registries and, where necessary, expert opinion and literature information.”
From Methods for causality assessment of idiosyncratic drug‐induced liver injury (2025) · cites this paper as [37]
The cited source says what the claim attributes to it.
In the citing paper
“In addition, DILI diagnosis will become more precise, reliable and consistent thanks to RECAM's enhanced objectivity and clarity [34].”
From DILI Differences and Similarities between the US and Europe (2026) · cites this paper as [34]
The cited source says what the claim attributes to it.
In the citing paper
“However, in a high-impact collaborative study, both the Spanish Registry and DILIN defined a new electronic causality scale called RECAM, which is an evidence-based update that is at least as effective as RUCAM at diagnosing DILI as expert opinion, but outperforms RUCAM at the diagnostic extremes [34] (Table 2).”
From DILI Differences and Similarities between the US and Europe (2026) · cites this paper as [34]
The cited source says what the claim attributes to it.
In the citing paper
“However, in a high-impact collaborative study, both the Spanish Registry and DILIN defined a new electronic causality scale called RECAM, which is an evidence-based update that is at least as effective as RUCAM at diagnosing DILI as expert opinion, but outperforms RUCAM at the diagnostic extremes [34] (Table 2).”
From DILI Differences and Similarities between the US and Europe (2026) · cites this paper as [34]
In the citing paper
“Diagnostic testing is categorical and menu‐driven to reduce interobserver variability.”
From Methods for causality assessment of idiosyncratic drug‐induced liver injury (2025) · cites this paper as [37]
In the citing paper
“Recently, a revised electronic version of RUCAM was developed, coined the Revised Electronic Causality Assessment Method (RECAM), using data from two large prospective DILI registries, the DILIN (Drug-Induced Liver Injury Network) and the Spanish DILI Registry.”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [64]
In the citing paper
“The original criteria of risk factors in RUCAM is removed in RECAM for lack of diagnostic value, so is competing medications to encourage assessment of each culprit drug.”
From Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update (2024) · cites this paper as [60]
In the citing paper
“RECAM is a recently reported evidence-based update with similar diagnostic efficacy to RUCAM but better precision and reliability because of its increased objectivity and clarity since it is an electronic algorithm integrated with LiverTox likelihood category [60].”
From Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update (2024) · cites this paper as [60]
In the citing paper
“The original criteria of risk factors in RUCAM is removed in RECAM for lack of diagnostic value, so is competing medications to encourage assessment of each culprit drug.”
From Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update (2024) · cites this paper as [60]
In the citing paper
“It demonstrated a better overall agreement with expert opinion and greater sensitivity for detecting patients in extreme DILI diagnostic categories (e.g., highly likely/probable; unlikely/excluded).”
From Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update (2024) · cites this paper as [60]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Abstract > Approach and Results:
“0.62 vs. 0.56 weighted kappa, p = 0.14”
§ A Revised Electronic Version of RUCAM for the Diagnosis of Drug Induced Liver Injury > Results > RECAM and RUCAM Performance:
“RECAM had better observed overall agreement compared to RUCAM (0.62 vs 0.56), although statistical significance was not reached (p=0.16)”
Citations
Cites
Simplified criteria for the diagnosis of autoimmune hepatitis
Hennes, E. M., Zeniya, M., Czaja, A. J., Parés, A., Dalekos, G. N., Krawitt, E. L., Bittencourt, P. L., Porta, G., Boberg, K. M., Hofer, H., et al. (2008) · Hepatology · doi:10.1002/hep.22322 · Cited by 1,901
Danan, G., & Benichou, C. (1993) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(93)90101-6 · Cited by 1,481
EASL Clinical Practice Guidelines: Drug-induced liver injury
Andrade, R. J., Aithal, G. P., Björnsson, E. S., Kaplowitz, N., Kullak-Ublick, G. A., Larrey, D., & Karlsen, T. H. (2019) · Journal of Hepatology · doi:10.1016/j.jhep.2019.02.014 · Cited by 1,276
Self-citationCase definition and phenotype standardization in drug-induced liver injury
Aithal, G. P., Watkins, P. B., Andrade, R. J., Larrey, D., Molokhia, M., Takikawa, H., Hunt, C. M., Wilke, R. A., Avigan, M., Kaplowitz, N., et al. (2011) · Clinical Pharmacology & Therapeutics · doi:10.1038/clpt.2011.58 · Cited by 944
Self-citationACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury
Chalasani, N. P., Hayashi, P. H., Bonkovsky, H. L., Navarro, V. J., Lee, W. M., & Fontana, R. J. (2014) · American Journal of Gastroenterology · doi:10.1038/ajg.2014.131 · Cited by 860
Self-citationANDRADE, R., LUCENA, M., FERNANDEZ, M., PELAEZ, G., PACHKORIA, K., GARCIARUIZ, E., GARCIAMUNOZ, B., GONZALEZGRANDE, R., PIZARRO, A., & DURAN, J. (2005) · Gastroenterology · doi:10.1016/j.gastro.2005.05.006 · Cited by 856
Self-citationRUCAM in Drug and Herb Induced Liver Injury: The Update
Danan, G., & Teschke, R. (2015) · International Journal of Molecular Sciences · doi:10.3390/ijms17010014 · Cited by 729
Incidence and Etiology of Drug-Induced Liver Injury in Mainland China
Shen, T., Liu, Y., Shang, J., Xie, Q., Li, J., Yan, M., Xu, J., Niu, J., Liu, J., Watkins, P. B., et al. (2019) · Gastroenterology · doi:10.1053/j.gastro.2019.02.002 · Cited by 615
Self-citationDrug-Induced Liver Injury Network (DILIN) Prospective Study: Rationale, Design and Conduct
Fontana, R. J., Watkins, P. B., Bonkovsky, H. L., Chalasani, N., Davern, T., Serrano, J., & Rochon, J. (2009) · Drug Safety · doi:10.2165/00002018-200932010-00005 · Cited by 486
Self-citationACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury
Chalasani, N. P., Maddur, H., Russo, M. W., Wong, R. J., Reddy, K. R., & on behalf of the Practice Parameters Committee of the American College of Gastroenterology (2021) · American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001259 · Cited by 430
Cited by
Sorted by citations
AASLD practice guidance on drug, herbal, and dietary supplement–induced liver injury
Fontana, R. J., Liou, I., Reuben, A., Suzuki, A., Fiel, M. I., Lee, W., & Navarro, V. (2023) · Hepatology · doi:10.1002/hep.32689 · Cited by 340
Self-citationThe exposome and liver disease - how environmental factors affect liver health
Barouki, R., Samson, M., Blanc, É., Colombo, M. G., Zucman‐Rossi, J., Lazaridis, K. N., Miller, G. W., & Coumoul, X. (2023) · Journal of Hepatology · doi:10.1016/j.jhep.2023.02.034 · Cited by 189
EASL Clinical Practice Guidelines on the management of autoimmune hepatitis
Dalekos, G., Gatselis, N., Drenth, J. P. H., Heneghan, M., Jørgensen, M., Lohse, A. W., Londoño, M., Muratori, L., Papp, M., Samyn, M., et al. (2025) · Journal of Hepatology · doi:10.1016/j.jhep.2025.03.017 · Cited by 175
Andrade, R. J., Aithal, G. P., de Boer, Y. S., Liberal, R., Gerbes, A., Regev, A., Terziroli Beretta-Piccoli, B., Schramm, C., Kleiner, D. E., De Martin, E., et al. (2023) · Journal of Hepatology · doi:10.1016/j.jhep.2023.04.033 · Cited by 166
Self-citationEfe, C., Kulkarni, A. V., Terziroli Beretta‐Piccoli, B., Magro, B., Stättermayer, A., Cengiz, M., Clayton‐Chubb, D., Lammert, C., Bernsmeier, C., Gül, Ö., et al. (2022) · Hepatology · doi:10.1002/hep.32572 · Cited by 106
Metadata
- Authors
- Hayashi, P. H., Lucena, M. I., Fontana, R. J., Bjornsson, E. S., Aithal, G. P., Barnhart, H., Gonzalez‐Jimenez, A., Yang, Q., Gu, J., Andrade, R. J., & Hoofnagle, J. H.
- Affiliations
- United States Food and Drug Administration (US)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES)
- University of Michigan (US)
- University of Iceland (IS)
- Nottingham University Hospitals NHS Trust (GB)
- Duke University (US)
- Servicio de Aparato Digestivo y de Farmacología Clínica,Hospital Universitario Virgen de la Victoria,Instituto de Investigación Biomédica de Málaga‐IBIMA,Facultad de Medicina,Universidad de Málaga,Málaga,Spain
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Corresponding author
- Hayashi, Paul H.
- Venue
- Hepatology
- Published
- 2022-03-22
- Volume
- 76
- Issue
- 1
- Pages
- 18-31
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- PMC
- PMC9233102
- OpenAlex
- W4206399120
- Cited by
- 160
- References
- 21
- Citations by year
- 2026: 36 · 2025: 29 · 2024: 46 · 2023: 25 · 2022: 22
- FWCI
- 17.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Repositorio Institucional de la Universidad de Málaga (University of Málaga) (publishedVersion, cc-by-nc-nd)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Opin vísindi (Opin vísindi) (submittedVersion, cc-by-nc-sa)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Opin vísindi (Opin vísindi) (submittedVersion, other-oa)
- Repositorio Institucional de la Universidad de Málaga (University of Málaga) (submittedVersion, other-oa)
- Funders
- American Association for the Study of Liver Diseases
- University of Pennsylvania (UL1 RR024986, UL1 RR024134, U01-DK100928)
- University of Texas Southwestern Medical Center (UL1TR000083, UL1‐RR024982, U01-DK083027, U01-DK083020, U01-DK082992, UL1 RR024986, UL1 RR024150, UL1 RR024134, U01-DK100928, UL1 RR025761)
- Georgia Clinical and Translational Science Alliance (UL1RR024986, UL1TR000083, UL1RR024982, UL1 RR024150, UL1 RR025761, UL1 RR024134)
- National Institutes of Health (5u01dk065211-22, UL1TR000083, 5u01dk065238-11, 5u01dk065193-05, 5u01dk065184-22, U01-DK065211)
- University of California, San Francisco
- Instituto de Salud Carlos III (PT 20/00127, PI18/01804)
- European Regional Development Fund (PI18/01804)
- National Cancer Institute
- National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK-065238, U01‐DK065193, U01 DK-065184, DK065211, U24DK065176, U01DK083023, DK065184, U01 DK-065211, U01DK082992, DK065176, DK065238, U01DK100928, U01DK083027, U01DK065201, U01DK083020)
- National Center for Research Resources (UL1RR024986, UL1RR024982, UL1RR025761, UL1RR024134, UL1RR024150)
- National Center for Advancing Translational Sciences
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Medicine › Pharmacology (medical) › Drug-Induced Adverse Reactions
- Keywords
- drug-induced liver injury, RUCAM, causality assessment, diagnostic criteria, Drug-Induced Liver Injury Network, classification trees
- MeSH terms
- Dyphylline, Electronics, Humans, Reproducibility of Results, Causality, Chemical and Drug Induced Liver Injury
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-11-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-11-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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