Cited by 615Drug-Induced Hepatotoxicity and ProtectionPharmacovigilance and Adverse Drug ReactionsLiver physiology and pathology

The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index; 4 of the 57 sources its claims cite were checked for support.

Incidence and Etiology of Drug-Induced Liver Injury in Mainland China

Open access

Shen, Tao, Liu, Yingxia, Shang, Jia, Xie, Qing, Li, Jun, Yan, Ming, Xu, Jianming, Niu, Junqi, Liu, Jiajun, Watkins, Paul B., Aithal, Guruprasad P., Andrade, Raúl J., Dou, Xiaoguang, Yao, Lvfeng, Lv, Fangfang, Wang, Qi, Li, Yongguo, Zhou, Xinmin, Zhang, Yuexin, Zong, Peilan, Wan, Bin, Zou, Zhengsheng, Yang, Dongliang, Nie, Yuqiang, Li, Dongliang, Wang, Yuya, Han, Xi’an, Zhuang, Hui, Mao, Yimin, Chen, Chengwei·2019·Gastroenterology

DOI 10.1053/j.gastro.2019.02.002

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Abstract

BACKGROUND & AIMS: We performed a nationwide, retrospective study to determine the incidence and causes of drug-induced liver injury (DILI) in mainland China. METHODS: We collected data on a total of 25,927 confirmed DILI cases, hospitalized from 2012 through 2014 at 308 medical centers in mainland China. We collected demographic, medical history, treatment, laboratory, disease severity, and mortality data from all patients. Investigators at each site were asked to complete causality assessments for each case whose diagnosis at discharge was DILI (n = 29,478) according to the Roussel Uclaf Causality Assessment Method. RESULTS: Most cases of DILI presented with hepatocellular injury (51.39%; 95% confidence interval [CI] 50.76-52.03), followed by mixed injury (28.30%; 95% CI 27.73-28.87) and cholestatic injury (20.31%; 95% CI 19.80-20.82). The leading single classes of implicated drugs were traditional Chinese medicines or herbal and dietary supplements (26.81%) and antituberculosis medications (21.99%). Chronic DILI occurred in 13.00% of the cases and, although 44.40% of the hepatocellular DILI cases fulfilled Hy's Law criteria, only 280 cases (1.08%) progressed to hepatic failure, 2 cases underwent liver transplantation (0.01%), and 102 patients died (0.39%). Among deaths, DILI was judged to have a primary role in 72 (70.59%), a contributory role in 21 (20.59%), and no role in 9 (8.82%). Assuming the proportion of DILI in the entire hospitalized population of China was represented by that observed in the 66 centers where DILI capture was complete, we estimated the annual incidence in the general population to be 23.80 per 100,000 persons (95% CI 20.86-26.74). Only hospitalized patients were included in this analysis, so the true incidence is likely to be higher. CONCLUSIONS: In a retrospective study to determine the incidence and causes of DILI in mainland China, the annual incidence in the general population was estimated to be 23.80 per 100,000 persons; higher than that reported from Western countries. Traditional Chinese medicines, herbal and dietary supplements, and antituberculosis drugs were the leading causes of DILI in mainland China.

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Written from the paper’s full text.

TL;DR

In a nationwide retrospective study of 25,927 confirmed drug-induced liver injury (DILI) cases from 308 mainland China centers (2012–2014), the estimated annual incidence in the general population was 23.80 per 100,000 (95% CI 20.86–26.74), higher than several Western estimates. Traditional Chinese medicines/herbal and dietary supplements and anti-tuberculosis drugs were the leading implicated single drug classes.

Key findings

Most cases presented as hepatocellular injury (51.39%; 95% CI 50.76–52.03), followed by mixed (28.30%; 95% CI 27.73–28.87) and cholestatic (20.31%; 95% CI 19.80–20.82); chronic DILI occurred in 13.00%, and 44.40% of hepatocellular cases met Hy’s Law criteria.
Severe outcomes were uncommon: 280 cases (1.08%) progressed to hepatic failure, 2 (0.01%) underwent liver transplantation, and 102 (0.39%) died; among deaths, DILI was judged primary in 72 (70.59%), contributory in 21 (20.59%), and no role in 9 (8.82%).
Leading single implicated classes were TCM/HDS (26.81%) and anti-TB drugs (21.99%); other single classes >1% included antineoplastics/immunomodulators (8.34%), anti-infectious agents (6.08%), psychotropics (4.90%), non-sex hormones (3.04%), cardiovascular drugs (2.98%), digestive drugs (2.04%), respiratory drugs (1.47%), and musculoskeletal drugs (1.32%).
Among 66 centers with complete capture, 13,691 DILI cases occurred among 8,102,732 inpatients (mean proportion 1.69‰; 95% CI 1.66–1.72); annual estimated incidence was 21.37, 23.86, and 26.00 per 100,000 in 2012, 2013, and 2014, averaging 23.80 per 100,000 (95% CI 20.86–26.74).

Methods

Retrospective multicentric “DILI-R” study at 308 medical centers in mainland China, searching inpatient discharge diagnoses from January 1, 2012 to December 31, 2014; of 29,478 initial DILI discharge cases, 80 with admission date out of range and 2,153 with missing data were excluded, leaving 27,245 with eligible data.
Causality assessment used RUCAM: cases with scores ≥6 (n=13,555) entered directly; cases with scores <6 (n=13,690) were reviewed by a panel of 3 hepatologists, and those judged probable DILI by at least two (n=12,372) were enrolled, yielding 25,927 eligible DILI cases.
Clinical type was classified by R value (hepatocellular ≥5.0, cholestatic ≤2.0, mixed 2.0–5.0); incidence was estimated using only the 66 centers with complete event capture as (DILI inpatients in 66 centers annually ÷ total inpatients in 66 centers annually) × (nationwide inpatients annually ÷ general population in mainland China annually), with SAS 9.3 and standard nonparametric/categorical tests.

Limitations

Paper-stated: only hospitalized patients were included, so the true incidence is likely higher; mild/moderate DILI patients who were unrecognized or managed as outpatients were not considered, and underdeveloped parts of the country not well covered by the survey have higher incidence of diseases requiring hepatotoxic drug treatment, so actual DILI incidence is very likely higher than 23.80 per 100,000.
Paper-stated: there were no entrance criteria based on liver chemistries, so the cohort may include more relatively mild cases than other registries; enrollment of children and teenagers (<18 years) was relatively low, possibly related to the limited number of pediatric hospitals participating; the panel did not evaluate why RUCAM scores were calculated as below 6 for enrolled cases.
Evident from design: retrospective discharge-diagnosis searching and incomplete capture at 242 centers may miss DILI cases; extrapolating incidence from 66 complete-capture centers to all mainland China assumes those centers are representative; no hospitals from Hong Kong, Macau, or Taiwan were included.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1053/j.gastro.2019.02.002

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 57 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

Show all 102 claims

Probably not a substantial claim. 23
It may state two separate claims as one. 30

Every source the paper cites for this claim was checked and supports it.
In the paper
“In the United States, the annual incidence of DILI in the general population has been recently estimated as 2.7 per 100,000 adults, through surveillance in the state of Delaware.”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > Abstract
What the sources say
- Supported
  The Results report an annual incidence of 2.7 DILI cases per 100,000 adult Delaware residents during the 2014 surveillance period. The Discussion describes this as the first population-based estimate in an American cohort. The paper cautions that gastroenterologist-only surveillance likely underestimated the actual incidence. (LLM, conf=0.93)
  cites [10] Vega, 2017, The incidence of drug- and herbal and dietary supplement-induced liver injury: preliminary findings from gastroenterologist-based surveillance in the population of the State of Delaware, Drug Saf source
Strength:hedged· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“females have been reported to have increased, 8,26,27,31 unchanged, 9,30 or even decreased 12,21 incidence of DILI (Table 4).”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT
What the sources say
- Not checked — no full text of the sourcecites [8] Bjornsson, 2013, Incidence, presentation, and outcomes in patients with drug-induced liver injury in the general population of Iceland, Gastroenterology source
- Not checked — no full text of the sourcecites [26] Takikawa, 2009, Drug-induced liver injury in Japan: an analysis of 1676 cases between 1997 and 2006, Hepatol Res source
- Could not verify
  The Results (Presenting Features; page unavailable) report that 60% of enrolled DILI patients were women, but do not compare DILI incidence by sex. The Discussion (page unavailable) finds no relationship between female sex and DILI severity and says susceptibility risk factors require comparison with controls. Neither passage establishes increased, unchanged, or decreased incidence in women. (LLM, conf=0.76)
  cites [27] Chalasani, 2008, Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States, Gastroenterology sourceExperimental — accuracy not yet measured
- Not checked — no full text of the sourcecites [31] Lucena, 2009, Phenotypic characterization of idiosyncratic drug-induced liver injury: the influence of age and sex, Hepatology source
- Not checked — no full text of the sourcecites [9] Sgro, 2002, Incidence of drug-induced hepatic injuries: a French population-based study, Hepatology source
- Not checked — no full text of the sourcecites [30] Hartleb, 2002, Drug-induced liver damage—a three-year study of patients from one gastroenterological department, Med Sci Monit
- Not checked — no full text of the sourcecites [12] Zhou, 2013, Epidemiology of drug-induced liver injury in China: a systematic analysis of the Chinese literature including 21,789 patients, Eur J Gastroenterol Hepatol source
- Partly supported
  The Demographic and Clinical Characteristics section reports a similar sex distribution among DILI cases, and the Discussion says there was no difference in sex distribution. This supports the ‘unchanged’ portion of the citing sentence, but the paper does not establish equal sex-specific incidence rates; it reports case distribution rather than incidence by sex. (LLM, conf=0.82)
  cites [21] Andrade, 2005, Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period, Gastroenterology sourceExperimental — accuracy not yet measured
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Liver injury caused by antineoplastic or immunomodulators includes hepatocyte necrosis, hepatic steatosis, hepatic mitochondrial injury, cholestasis and vascular injury.[42][43][44][45]”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > A C C E P T E D ACCEPTED MANUSCRIPT
What the sources say
- Not checked — no full text of the sourcecites [42] Wang, 2012, Non-genetic risk factors and predicting efficacy for docetaxel—drug-induced liver injury among metastatic breast cancer patients, J Gastroenterol Hepatol source
- Partly supported
  The Additional information table (page not provided) reports hepatocyte necrosis and a case with mild cholestasis after imatinib treatment. The Discussion (page not provided) describes hepatic microthrombi in another case, but links them to the patient’s underlying prothrombotic condition; the paper does not report steatosis or mitochondrial injury. It therefore supports only part of the broader list attributed to it. (LLM, conf=0.87)
  cites [43] Ridruejo, 2007, Imatinib-induced fatal acute liver failure, World J Gastroenterol sourceExperimental — accuracy not yet measured
- Not checked — no full text of the sourcecites [44] Ma, 2002, Acute toxicity of adjuvant doxorubicin and cyclophosphamide for early breast cancer—a retrospective review of Chinese patients and comparison with an historic Western series, Radiother Oncol source
Strength:plain· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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 highest proportion of DILI cases were in patients with ages between 40 and 59 years followed by ages 18-39, ages ≥ 60 and ages < 18 years old.”
- Also stated in: § Demographic features · plain
  “Thus, DILI in children and teenagers represented the lowest proportion of the subjects enrolled.”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > Demographic features
Strength:plain· not yet calibratedn = 25,927
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
In the paper
“Also, the most common causative drugs were anti-infectious agents, anti-TB drugs and natural herbal medicines across various registries.”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > Abstract
What the sources say
- Not checked — no full text of the sourcecites [11] Leise, 2014, Drug-induced liver injury, Mayo Clin Proc source
Strength:plain· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Two population-based studies conducted in France and Iceland estimated the annual incidences of DILI to be approximately 13.9/100,000 and 19.1/100,000 respectively.”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > Abstract
What the sources say
- Not checked — no full text of the sourcecites [8] Bjornsson, 2013, Incidence, presentation, and outcomes in patients with drug-induced liver injury in the general population of Iceland, Gastroenterology source
- Not checked — no full text of the sourcecites [9] Sgro, 2002, Incidence of drug-induced hepatic injuries: a French population-based study, Hepatology source
Strength:hedged· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“In the west, the incidence of DILI has been estimated to be 1/100,000-20/100,000 in the general population.”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > Abstract
What the sources say
- Not matched
  Couldn’t be matched to a paper in Crossref, so it can’t be checked.
  cites 2,[4][5][6][7]
Strength:hedged· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“which was still higher than that estimated in Iceland (19.1/100,000) 7 , France (13.9/100,000), 9 the United states (2.7/100,000), 10 Spain (3.42/100,000) 21 and Sweden (2.4/100,000) 22 (Table 4).”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > A C C E P T E D Discussion
What the sources say
- Not checked yet
  Checked before — its earlier verdict is held back until a new check runs.
  cites [7] Bjornsson, 2010, Review article: drug-induced liver injury in clinical practice, Aliment Pharmacol Ther source
- Not checked — no full text of the sourcecites [9] Sgro, 2002, Incidence of drug-induced hepatic injuries: a French population-based study, Hepatology source
- Not checked yet
  Checked before — its earlier verdict is held back until a new check runs.
  cites [10] Vega, 2017, The incidence of drug- and herbal and dietary supplement-induced liver injury: preliminary findings from gastroenterologist-based surveillance in the population of the State of Delaware, Drug Saf source
Strength:hedged· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Drug-induced liver injury (DILI) is a common adverse drug reaction (ADR), and it can lead to liver failure and even death.[1][2][3]”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > Abstract
What the sources say
- Not checked — no full text of the sourcecites [1] Kaplowitz, 2005, Idiosyncratic drug hepatotoxicity, Nat Rev Drug Discov source
- Not checked — no full text of the sourcecites [2] Navarro, 2006, Drug-related hepatotoxicity, N Engl J Med source
- Not checked — no full text of the sourcecites [3] Chalasani, 2014, ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury, Am J Gastroenterol source
Strength:plain· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Though females are suggested to have a higher risk of idiosyncratic DILI than males in many retrospective studies, 8,[27][28][29][30]”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT
What the sources say
- Not checked — no full text of the sourcecites [8] Bjornsson, 2013, Incidence, presentation, and outcomes in patients with drug-induced liver injury in the general population of Iceland, Gastroenterology source
- Not checked yet
  Checked before — its earlier verdict is held back until a new check runs.
  cites [27] Chalasani, 2008, Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States, Gastroenterology source
- Not checked — no full text of the sourcecites [28] Suk, 2012, A prospective nationwide study of drug-induced liver injury in Korea, Am J Gastroenterol source
- Not checked — no full text of the sourcecites [29] De Valle, 2006, Drug-induced liver injury in a Swedish University hospital out-patient hepatology clinic, Aliment Pharmacol Ther source
- Not checked — no full text of the sourcecites [30] Hartleb, 2002, Drug-induced liver damage—a three-year study of patients from one gastroenterological department, Med Sci Monit
Strength:hedged· not yet calibratedCausal:conditional· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Investigators at each site were asked to complete causality assessment scoring for each case whose diagnosis at discharge was DILI (n=29,478) according to the Roussel Uclaf Causality Assessment Method (RUCAM).”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > A C C E P T E D ACCEPTED MANUSCRIPT
What the sources say
- Not checked — no full text of the sourcecites [14] Danan, 1993, Causality assessment of adverse reactions to drugs—I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries, J Clin Epidemiol source
- Not checked — no full text of the sourcecites [15] Benichou, 1993, Causality assessment of adverse reactions to drugs—II. An original model for validation of drug causality assessment methods: case reports with positive rechallenge, J Clin Epidemiol source
Load-bearingStrength:plain· not yet calibratedn = 29,478
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“As reported by the western studies, acute liver failure was most associated with use of non-steroidal anti-inflammatory drugs (NSAIDs), anti-infective drugs, and herbs and dietary supplements (HDS).13,33,34”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > A C C E P T E D ACCEPTED MANUSCRIPT
What the sources say
- Not checked yet
  Checked before — its earlier verdict is held back until a new check runs.
  cites [13] Yu, 2017, CSH guidelines for the diagnosis and treatment of drug-induced liver injury, Hepatol Int source
- Not checked — no full text of the sourcecites [33] Russo, 2004, Liver transplantation for acute liver failure from drug induced liver injury in the United States, Liver Transpl source
- Not checked — no full text of the sourcecites [34] Bjornsson, 2005, Fulminant drug-induced hepatic failure leading to death or liver transplantation in Sweden, Scand J Gastroenterol source
Strength:plain· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“All these anti-TB drugs have hepatotoxicity potential and could lead to DILI during M A N U S C R I P T ## A C C E P T E D ACCEPTED MANUSCRIPT anti-tuberculosis treatment, which commonly leads to interruption of anti-TB treatment and may promote antibiotic resistance.40”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > A C C E P T E D ACCEPTED MANUSCRIPT
What the sources say
- Not checked — no full text of the sourcecites [40] Frieden, 2003, Tuberculosis. Lancet source
Strength:hedged· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
In the paper
“Among TB patients, male to female ratio was 2.1:1.32”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT
What the sources say
- Not matched
  Couldn’t be matched to a paper in Crossref, so it can’t be checked.
  cites [32] 2016
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“In China, it was estimated that 918,000 individuals suffered from tuberculosis (TB) (including TB co-infected with HIV) with overall incidence of 67/100,000 population, which accounted for 8.65% of the world's reported cases of TB in 2015 (WHO Global tuberculosis report 2016).32”
§ Incidence and Etiology of Drug-Induced Liver Injury in Mainland China > M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT
What the sources say
- Not matched
  Couldn’t be matched to a paper in Crossref, so it can’t be checked.
  cites [32] 2016
Strength:hedged· not yet calibratedn = 918,000
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

49 of 49

The authors state this as an assumption.
The proportion of DILI in the entire hospitalized population of China is represented by that observed in the 66 centers where DILI capture was complete.
“Assuming the proportion of DILI in the entire hospitalized population of China was represented by that observed in the 66 centers where DILI capture was complete”
The paper relies on this without support.
The ratio of DILI inpatients to total inpatients in the 66 centers with complete event capture is representative of the ratio in all hospitals in mainland China.
“The incidence of DILI in the general population was evaluated as (number of DILI inpatients in 66 centers annually ÷ total number of inpatients in 66 centers annually) × (number of inpatients nationwide annually ÷ the general population in mainland China annually).”
The paper relies on this without support.
The 25,927 DILI cases collected from 308 medical centers are representative of hospitalized DILI patients in mainland China.
“In this study, a total of 25,927 DILI cases among hospitalized patients were collected from 308 medical centers between January 1, 2012 and December 31, 2014 (Figure 1A).”
The paper relies on this without support.
In mainland China, health care of Chinese inhabitants has been covered by the public medical service system, medical insurance system and the rural cooperative medical system since 2003.
“In mainland China, health care of Chinese inhabitants has been covered by the public medical service system, medical insurance system and the rural cooperative medical system since 2003.”
The paper relies on this without support.
In mainland China, hepatoprotective agents are generally administered to hospitalized patients with DILI.
“In addition, in mainland China, hepatoprotective agents are generally administered to hospitalized patients with DILI.”
The paper relies on this without support.
The 66 centers that provided all recorded hospitalized DILI cases are representative of all hospitals in mainland China for estimating the proportion of DILI among inpatients.
“Of the 308 medical centers that participated in this study, only 66 centers provided all recorded hospitalized DILI cases during the three-year observation period and could therefore be used to estimate the proportion of DILI patients among all inpatients.”
The paper relies on this without support.
The gender distribution ratio among TB patients is the expected ratio among DILI patients due to TB treatments if susceptibility to DILI is not affected by gender.
“Among TB patients, male to female ratio was 2.1:1.32”
The paper relies on this without support.
The 66 centers that provided complete enrollment are representative of all 308 centers and of mainland China for estimating DILI incidence.
“Of the 308 involved centers, only 66 centers provided all recorded hospitalized DILI cases during 3-year observation (red dots).Thus, DILI cases from these 66 centers were used to assess the diagnostic rate of DILI in this study, since all inpatients were screened for the occurrence of DILI.”

8 of 8

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?

Causality assessment of adverse reactions to drugs—I. A novel method based on the conclusions of international consensus meetings: Application to drug-induced liver injuries
Danan, G., & Benichou, C. (1993) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(93)90101-6 · Cited by 1,481
Idiosyncratic drug hepatotoxicity
Kaplowitz, N. (2005) · Nature Reviews Drug Discovery · doi:10.1038/nrd1750 · Cited by 1,054
Features and outcomes of 899 patients with drug-induced liver injury: the DILIN Prospective Study
Chalasani, N., Bonkovsky, H. L., Fontana, R., Lee, W., Stolz, A., Talwalkar, J., Reddy, K. R., Watkins, P. B., Navarro, V., Barnhart, H., et al. (2015) · Gastroenterology · doi:10.1053/j.gastro.2015.03.006 · Cited by 925
Self-citation
Incidence, Presentation, and Outcomes in Patients With Drug-Induced Liver Injury in the General Population of Iceland
Björnsson, E. S., Bergmann, O. M., Björnsson, H. K., Kvaran, R. B., & Olafsson, S. (2013) · Gastroenterology · doi:10.1053/j.gastro.2013.02.006 · Cited by 865
ACG 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
Drug-Induced Liver Injury: An Analysis of 461 Incidences Submitted to the Spanish Registry Over a 10-Year Period
ANDRADE, 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-citation
Drug-Related Hepatotoxicity
Navarro, V. J., & Senior, J. R. (2006) · New England Journal of Medicine · doi:10.1056/nejmra052270 · Cited by 811
Causes, Clinical Features, and Outcomes From a Prospective Study of Drug-Induced Liver Injury in the United States
Chalasani, N., Fontana, R. J., Bonkovsky, H. L., Watkins, P. B., Davern, T., Serrano, J., Yang, H., & Rochon, J. (2008) · Gastroenterology · doi:10.1053/j.gastro.2008.09.011 · Cited by 755
Self-citation
Incidence of drug-induced hepatic injuries: A French population-based study
Sgro, C., Clinard, F., Ouazir, K., Chanay, H., Allard, C., Guilleminet, C., Lenoir, C., Lemoine, A., & Hillon, P. (2002) · Hepatology · doi:10.1053/jhep.2002.34857 · Cited by 716
Tuberculosis
Frieden, T. R., Sterling, T. R., Munsiff, S. S., Watt, C. J., & Dye, C. (2003) · The Lancet · doi:10.1016/s0140-6736(03)14333-4 · Cited by 689

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Items 301–400 of 615

Hepatic Macrophage activation and the LPS pathway in patients with different degrees of severity and histopathological patterns of drug induced liver injury.
Du, H., Zhao, S., Zhao, W. T., Fu, N., Li, W., Qin, X.-J., Zhang, Y., Nan, Y., & Zhao, J. (2021) · PubMed · doi:10.14670/hh-18-340 · Cited by 8
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Establishment of a Stable Acute Drug-Induced Liver Injury Mouse Model by Sodium Cyclamate
Zhou, Q., Peng, Z., & Huang, X. (2022) · Journal of Inflammation Research · doi:10.2147/jir.s354273 · Cited by 8
Of Potions, Poisons, Polygonum, and Pre‐emptive Polymorphism
Aithal, G. P. (2019) · Hepatology · doi:10.1002/hep.30798 · Cited by 8
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Can retrospective studies confirm causes of drug-induced liver injury?
Yang, M., Li, Z., & Dou, D. (2019) · Gastroenterology · doi:10.1053/j.gastro.2019.03.078 · Cited by 8
RE: Incidence and etiology of drug-induced liver injury in mainland China
Devarbhavi, H., & Bjornsson, E. S. (2019) · Gastroenterology · doi:10.1053/j.gastro.2019.06.045 · Cited by 8
Protective effects of liensinine against acetaminophen-induced liver injury through relieving inflammation, oxidative stress, and apoptosis
Suo, Y., Li, S., Fu, C., Chai, X., Liao, J., Wong, Y., Lyu, H., & Xu, C. (2025) · Science of Traditional Chinese Medicine · doi:10.1097/st9.0000000000000056 · Cited by 7
In vitro liver models for toxicological research
Fukunaga, I., & Takebe, T. (2025) · Drug Metabolism and Pharmacokinetics · doi:10.1016/j.dmpk.2025.101478 · Cited by 7
Doxorubicin promotes NK cell dysfunction and induces acute liver injury through kynurenine-AhR axis
Tang, B., Ouyang, H., Zheng, S., Yu, L., Xiao, R., Wu, L., & Wang, Z. (2025) · International Immunopharmacology · doi:10.1016/j.intimp.2025.114489 · Cited by 7
Emodin and physcion alleviate cholestatic liver injury by targeting FXR: hepatoprotective components identified in processed Polygonum multiflorum Thunb. using a comprehensive two-dimensional biochromatography system
Li, Z., Gu, Y., Yang, J., Wang, S., Li, S., Chen, P., Yao, R., Liu, F., Wang, Y., Wang, R., et al. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1706401 · Cited by 7
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ROS-scavenging nanoparticles loaded with tectorigenin protect against acetaminophen-induced hepatotoxicity by interrupting the calcium/ROS-mediated pathogenic endoplasmic reticulum–Mitochondrial signaling cascade
Zhang, Y., Jin, Z., Xu, L., Zhong, Z., Wang, X., Gao, C., & Li, L. (2025) · Bioactive Materials · doi:10.1016/j.bioactmat.2025.12.016 · Cited by 7
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Prevalence and clinical profiles of primary sclerosing cholangitis in China: Data from electronic medical records and systematic literature retrieval
Xu, X., Meng, T., Shi, L., Duan, W., Niu, J., Ding, H., Xie, W., Zhou, L., Wang, B., Li, J., et al. (2024) · Journal of Autoimmunity · doi:10.1016/j.jaut.2024.103264 · Cited by 7
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Novel reduced heteropolyacid nanoparticles for effective treatment of drug-induced liver injury by manipulating reactive oxygen and nitrogen species and inflammatory signals
Yang, Y., Chen, Q., Liu, Z., Huang, T., Hong, Y., Li, N., Ai, K., & Huang, Q. (2024) · Journal of Colloid and Interface Science · doi:10.1016/j.jcis.2024.08.239 · Cited by 7
Treatment of Insomnia With Traditional Chinese Medicine Presents a Promising Prospect
Zhang, B., Wang, Q., Zhang, Y., Wang, H., Kang, J., Zhu, Y., Wang, B., & Feng, S. (2025) · Phytotherapy Research · doi:10.1002/ptr.8495 · Cited by 9
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Monocyte-Derived Hepatocyte-Like Cell Test: A Novel Tool for in vitro Identification of Drug-Induced Liver Injury in Patients with Herbal or Dietary Supplements
Weber, S., Wong, G. L., Wong, V. W. S., Benesic, A., Chan, H. L., & Gerbes, A. L. (2020) · Digestion · doi:10.1159/000509391 · Cited by 7
UPLC-MS/MS method for simultaneously determining nucleosides and methyl-nucleosides in liver mRNA of Epimedin C-induced liver injury mouse model
Song, Z., Li, Z., Wen, X., Liu, R., & Tian, X. (2021) · Chinese Medicine · doi:10.1186/s13020-021-00501-7 · Cited by 7
Hepatic Polarized Differentiation Promoted the Maturity and Liver Function of Human Embryonic Stem Cell-Derived Hepatocytes via Activating Hippo and AMPK Signaling Pathways
Wang, J., Situ, P., Chen, S., Wu, H., Zhang, X., Liu, S., Wang, Y., Xie, J., Chen, H., & Duan, Y. (2022) · Cells · doi:10.3390/cells11244117 · Cited by 7
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Ferulic acid prevents Diosbulbin B-induced liver injury by inhibiting covalent modifications on proteins
Chen, H., Liu, C., Li, M., Zhang, Y., Wang, Z., Jiang, Q., Wang, Q., Wang, Q., & Zhuo, Y. (2023) · Drug Metabolism and Pharmacokinetics · doi:10.1016/j.dmpk.2023.100507 · Cited by 7
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Risk factors for irinotecan-induced liver injury: a retrospective multicentre cross-sectional study in China
Han, J., Liu, J., Yu, Z., Huang, R., Zhao, L., Xu, Y., Chen, M., He, G., Song, Q., Li, W., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-069794 · Cited by 7
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Bioinformatics approach and experimental validation reveal the hepatoprotective effect of pachyman against acetaminophen-associated liver injury
Wu, K., Qin, J., Liu, M., Yan, X., & Guo, C. (2023) · Aging · doi:10.18632/aging.205000 · Cited by 7
Network meta-analysis of different liver protective drugs in the treatment of drug-induced liver injury
Li, C., Yang, X., Quan, Y., Wu, A., & Wang, Y. (2023) · Medicine · doi:10.1097/md.0000000000036538 · Cited by 7
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Influence of Sex in the Development of Liver Diseases
Zhang, J., Zhang, N., Lyu, Y., & Zhang, X. (2025) · Seminars in Liver Disease · doi:10.1055/a-2516-0261 · Cited by 7
Second-Generation Cephalosporins-Associated Drug-Induced Liver Disease: A Study in VigiBase with a Focus on the Elderly
Sipos, M., Farcas, A. M., Leucuta, D., Bucșa, C., Hurubă, M., & Mogoșan, C. (2021) · Pharmaceuticals · doi:10.3390/ph14050441 · Cited by 7
DILI Cases in Registries and Databases: An Analysis of Quality
Teschke, R., & Danan, G. (2021) · The International Journal of Gastroenterology and Hepatology Diseases · doi:10.2174/2666290601666210325091553 · Cited by 7
Association of ABO blood group and antituberculosis drug‐induced liver injury: A case‐control study from a Chinese Han population
Tao, B., Yang, M., Chen, H., Pan, H., Liu, W., Yi, H., & Tang, S. (2020) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/jcpt.13139 · Cited by 7
Characteristics of Drug-Induced Liver Injury in Northeast China: Disease Spectrum and Drug Types
Zhang, C., Wu, Y., Yuan, S., Dou, X., Sheng, Q., Wang, J., Tian, W., Yao, L., & Ding, Y. (2020) · Digestive Diseases and Sciences · doi:10.1007/s10620-019-06030-6 · Cited by 6
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Risk factors related to significant hepatic inflammation in patients with acute drug-induced liver injury
Xiong, Y.-T., Wang, J.-F., Li, L., Bai, Z.-F., Liu, Y., Huang, A., Wang, K.-X., Fu, Y., Yang, W., Guo, C., et al. (2024) · iLIVER · doi:10.1016/j.iliver.2024.100095 · Cited by 6
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ScRNA-seq combined with ATAC-seq analysis to explore the metabolic balance mechanism of CCl4-induced liver inflammatory injury
Liu, H., Zhang, Y., & Ning, S. (2025) · Frontiers in Immunology · doi:10.3389/fimmu.2025.1600685 · Cited by 6
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Antitubercular drug induced liver injury among tuberculosis patients in central Ethiopia
Petros, Z., Tamirat, A., & Assefa, W. (2025) · Scientific Reports · doi:10.1038/s41598-025-15855-3 · Cited by 6
Compatibility with Fructus Ligustri Lucidi Effectively Mitigates Idiosyncratic Liver Injury of Epimedii Folium by Modulating NOD-like Receptor Family Pyrin Domain Containing 3 Inflammasome Activation
Zhao, X., Wu, Z., Wang, Y., Xu, Y., Ye, X., Dong, X., Li, J., Lv, G.-J., Wang, S., Li, Y., et al. (2024) · World Journal of Traditional Chinese Medicine · doi:10.4103/wjtcm.wjtcm_61_24 · Cited by 6
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Development of a Novel In Silico Classification Model to Assess Reactive Metabolite Formation in the Cysteine Trapping Assay and Investigation of Important Substructures
Umemori, Y., Handa, K., Yoshimura, S., Kageyama, M., & Iijima, T. (2024) · Biomolecules · doi:10.3390/biom14050535 · Cited by 6
Drug-Induced Liver Injury Due to Doxycycline: A Case Report and Review of Literature
Nikolajevic, N., Nikolajevic, M., Pantić, I., Korica, B., Kotseva, M., Alempijevic, T. M., Jevtic, D., Madrid, C., & Dumic, I. (2024) · Cureus · doi:10.7759/cureus.59687 · Cited by 6
Inhibitory Effects of Alkaloids on OATP1B1 In Vitro and In Vivo: Prediction for Food/Herb–Drug Interactions and Hepatoprotective Effects Based on Structure–Activity Relationships
Sun, Y., Tan, H., Wang, F., Hu, J., Duan, X., Bai, W., Wu, J., Bai, J., & Hu, J. (2025) · Chemical Research in Toxicology · doi:10.1021/acs.chemrestox.4c00418 · Cited by 6
Specific Hepatorenal Toxicity and Cross-Species Susceptibility of Eight Representative Pesticides
Liu, Y., Xu, N., Song, X., Deng, M., Sun, R., Wang, P., & Cao, L. (2025) · Toxics · doi:10.3390/toxics13110911 · Cited by 6
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Elucidation of Cortex Dictamni hepatotoxicity mechanism by integrated serum pharmacochemistry and metabolomics
Liu, S., Jiaxin, R. U. A. N., Chen, W. A. N. G., Wang, X., Yan, J., Yu, D., Zhang, N., Chen, P., Wang, Y., Lü, F., et al. (2025) · Phytomedicine · doi:10.1016/j.phymed.2025.157631 · Cited by 6
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Application of 3D Hepatic Plate-Like Liver Model for Statin-Induced Hepatotoxicity Evaluation
Xu, J., Pan, D., Liao, W., Jia, Z., Pan, M., Weng, J., Han, X., Li, S., Li, Y., Liang, K., et al. (2022) · Frontiers in Bioengineering and Biotechnology · doi:10.3389/fbioe.2022.826093 · Cited by 6
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Bushen Jianpi Formula Combined with Entecavir for the Treatment of HBeAg-Negative Chronic Hepatitis B: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial
Zhang, J., Zhang, X., Zhou, Z., Zhu, X., Zheng, C., Li, M., Jin, S.-G., Mao, D., Xue, J., Shi, W.-B., et al. (2022) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2022/6097221 · Cited by 6
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Kuhuang injection exerts a protective effect by activating PPAR-γ in an in vitro model of chlorpromazine-induced cholestatic liver injury constructed by tissue engineering
Wu, Q., Duan, Z., Huang, L., & Li, Z. (2022) · Pharmaceutical Biology · doi:10.1080/13880209.2022.2110128 · Cited by 6
Development and validation of a novel model to predict liver-related mortality in patients with idiosyncratic drug-induced liver injury
Wang, Y., Zou, C., Zhang, J., Qiu, L., Huang, Y., Zhao, X., Zou, Z., & Jia, J. (2023) · Hepatobiliary & pancreatic diseases international · doi:10.1016/j.hbpd.2023.06.002 · Cited by 6
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Lipidomics reveals the lipid metabolism disorders in Fructus Psoraleae-induced hepatotoxicity in rats with kidney-yin deficiency syndrome
Wu, X., Xie, L., He, J., Yan, X., Zhang, F.-F., Xu, Y., & Li, Y. (2023) · Journal of Chromatography B · doi:10.1016/j.jchromb.2023.123898 · Cited by 6
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Cyclosporine-A induced cytotoxicity within HepG2 cells by inhibiting PXR mediated CYP3A4/CYP3A5/MRP2 pathway
Shang, S., Li, W., Zhou, F., Zhao, Y., Yu, M., Tong, L., Xin, H., & Yu, A. (2024) · Drug and Chemical Toxicology · doi:10.1080/01480545.2023.2276084 · Cited by 6
Clinical Features and Risk Factors for Drug-Induced Liver Injury: A Retrospective Study From China
Ma, X., Chen, Z., An, J., & Zhang, C. (2024) · Clinical Therapeutics · doi:10.1016/j.clinthera.2024.04.014 · Cited by 6
3,3′,5-triiodo-l-thyronine inhibits drug-induced liver injury through activation of PPARα as revealed by network pharmacology and biological experimental verification
Liu, K., Chen, X., Ren, Y., Liu, C., Zhang, J., Wang, Z., Li, Y., & Zhang, Y. (2022) · Toxicology and Applied Pharmacology · doi:10.1016/j.taap.2022.116098 · Cited by 6
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Gut Microbiota and Drug-Related Liver Injury: Challenges and Perspectives
Su, Y., Lü, N., Li, Q., Wen, H., Zhang, X. Q., & Zhang, M. (2023) · Advanced Gut & Microbiome Research · doi:10.1155/2023/5442597 · Cited by 6
Prognostic risk factors for patients with hepatic sinusoidal obstruction syndrome caused by pyrrolizidine alkaloids
Du, X., Liu, Z., Yu, H., Wang, Y., Zou, Z., Wei, H., Liang, J., Yang, D., Liu, Y., Zhang, J., et al. (2023) · Medicine · doi:10.1097/md.0000000000034698 · Cited by 6
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Markers involved in proinflammatory effects by environmental toxicants
Smiljevska-Ristovska, V., Sabriu-Haxhijaha, A., Ristoski, T., Kosharkoska‐Spasovska, F., Krstanoski, L., & Dimitrova‐Shumkovska, J. (2020) · Toxicology Mechanisms and Methods · doi:10.1080/15376516.2020.1791293 · Cited by 6
Clarify the potential cholestatic hepatotoxicity components from Chinese Herb Medicine and metabolism’s role via hBSEP vesicles and S9/hBSEP vesicles
Li, Y., Yan, D., Jin, J., Tan, B., Chen, X., Zou, B., Song, G., Weng, F., Liu, C., & Qiu, F. (2022) · Toxicology in Vitro · doi:10.1016/j.tiv.2022.105324 · Cited by 6
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Sacubitril/valsartan-induced liver injury: A case report and literature review
Zhang, T., Cai, J.-L., & Yu, J. (2023) · Medicine · doi:10.1097/md.0000000000034732 · Cited by 6
Journal of Cardiovascular Diseases & Diagnosis
(2019) · Journal of Cardiovascular Diseases & Diagnosis · doi:10.4172/2329-9517 · Cited by 6
Hepatoprotective activity assessment of amino acids derivatives of picroside I and II
Dong, P., Gao, Z., Yin, X., Li, Z., & Han, H. (2021) · Chemical Biology & Drug Design · doi:10.1111/cbdd.13786 · Cited by 5
Protective effects of turmeric extract, curcumin, demethoxycurcumin, bis-demethoxycurcumin, and ar-turmerone from Curcuma longa L. rhizomes on acetaminophen-induced hepatotoxicity in HepG2 cells
Widowati, W., Laksmıtawatı, D. R., Pratamı, D. K., Rahmat, D., Kiran, S. R., Devi, J. A., Priyandoko, D., Dewi, N. S. M., Sutendi, A. F., Azis, R., et al. (2025) · Asian Pacific Journal of Tropical Biomedicine · doi:10.4103/apjtb.apjtb_770_24 · Cited by 5
Protective effects of Atractylodes macrocephala polysaccharides on acetaminophen-induced liver injury
Wu, J., Jia, B., Gong, S., Li, Y., Wang, J., Huang, Y., & Guo, J. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1583334 · Cited by 5
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Clinical guidelines. Drug-induced liver injury (DILI) in adults
Drapkina, O. M., Maev, I. V., Ахмедов, В. А., Вологжанина, Л. Г., Dolgushina, A. I., Игумнова, О. А., Козлова, И. В., Лазебник, Л. Б., Okovityi, S. V., Pirogova, I. Y., et al. (2024) · Экспериментальная и клиническая гастроэнтерология · doi:10.31146/1682-8658-ecg-232-12-5-48 · Cited by 5
Research progress of dissolving microneedles in the field of component administration of traditional Chinese medicine
Yang, Y., Zhang, T., Niu, B., Wang, X., Liu, L., Zhu, P., & Meng, F. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1623476 · Cited by 5
Geniposide induces hepatotoxicity via the bile acid-induced activation of NLRP3 inflammasome and regulation of the FXR/PERK/TXNIP pathway
Jin, Z., Cheng, S., Liu, B., Liu, Y., Wei, Y., Hao, X., & Li, H. (2025) · Toxicology Letters · doi:10.1016/j.toxlet.2025.111740 · Cited by 5
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The validation of histological criteria from the IAIH‐PG to distinguish AIH from drug‐induced liver injury
Ma, Z., Wang, L., Liu, J., Saxena, R., Chen, Z., Zhang, X., Wang, H., Vij, M., Komuta, M., Soon, G. S. T., et al. (2025) · Histopathology · doi:10.1111/his.70027 · Cited by 5
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Drug-induced liver injury: a real-world pharmacovigilance study using the FDA Adverse Event Reporting System database (2004–2024)
Li, D., Wang, D., Huang, G., Liu, Q., Wang, Y., Zhang, R., Liu, S., & Du, Q. (2025) · Annals of Hepatology · doi:10.1016/j.aohep.2025.102156 · Cited by 4
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Unraveling the Role of CYP2E1 in Antitubercular Drug–Induced Hepatotoxicity: From Molecular Mechanisms to Clinical Implications
Bishnu, D., Santra, S., Purkait, S., & Santra, A. K. (2025) · International Journal of Hepatology · doi:10.1155/ijh/9980298 · Cited by 5
Review on traditional Chinese medicine-induced liver injury
Wu, J., Zhu, Y., Du, X., Li, Q., Chen, P., Zhang, Y., Liu, S., Yue, X., Liang, A., & Han, J. (2025) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2025.120949 · Cited by 5
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Baseline lymphocyte and cholinesterase levels may be the predictors of chronic herbal drug–induced liver injury
Zeng, Z., Yi, W., Dong, J.-P., Chen, Q., Sun, F., Lu, H., Lin, Y., Bi, X., Yang, L., Lu, Y., et al. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.962480 · Cited by 5
Nucleic acids and proteins carried by exosomes from various sources: Potential role in liver diseases
Xie, D., Qian, B., & Li, X. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.957036 · Cited by 5
Hepatoprotective Effect of Ethanolic Pomegranate Peel Extract Against Levofloxacin via Suppression of Oxidative Stress, Proinflammation, and Apoptosis in Male Rats
El-Demerdash, F. M., Minjal, A. H., El-Sayed, R. A., & Baghdadi, H. H. (2024) · Journal of Medicinal Food · doi:10.1089/jmf.2023.0215 · Cited by 5
Exposure to Gynura japonica (Thunb.) Juel plants induces hepatoxicity in rats and Buffalo rat liver cells
Wen, C., Zhou, T., Chang, Y., Wei, Y., Zhang, H., & Yang, Z. (2024) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2024.118692 · Cited by 5
Azithromycin induces liver injury in mice by targeting the AMPK/Nrf2 pathway
Xu, Q., Zhang, C., Lu, J., Qian, H., Wang, X., Guo, W., & Cheng, H. (2024) · Immunopharmacology and Immunotoxicology · doi:10.1080/08923973.2024.2415115 · Cited by 5
Research Methods for “Dose-Effect-Toxicity” Relationship of Chinese Medicine Herbs
Zuo, Q., Yan, F., Cui, D., Zhao, Y. L., Fu, R., Xu, D., & Tang, Y. (2025) · Chinese Journal of Integrative Medicine · doi:10.1007/s11655-025-4006-7 · Cited by 5
Correlation between serum cytokines and clinicopathological features in patients with drug-induced liver injury
Zhang, Y., Gao, H., Zhang, Y., Shao, Y., Zhang, R., & Wen, X. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.1070802 · Cited by 5
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Effects of drug-induced liver injury on the in vivo fate of liposomes
Liu, M., Wu, E., Pan, F., Tian, K., Fu, J., Yu, Y., Guo, Z., Ma, Y., Wei, A., Yu, X., et al. (2024) · European Journal of Pharmaceutics and Biopharmaceutics · doi:10.1016/j.ejpb.2024.114389 · Cited by 5
The genetic variants in calcium signaling related genes influence anti-tuberculosis drug induced liver injury
Lyu, M., Zhou, J., Chen, H., Bai, H., Song, J., Liu, T., Cheng, Y., & Ying, B. (2019) · Medicine · doi:10.1097/md.0000000000017821 · Cited by 5
Drug-Induced Liver Injury
Li, Y., & Zhou, H. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-820472-6.00008-6 · Cited by 5
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Liver dysfunction during COVID-19 pandemic: Contributing role of associated factors in disease progression and severity
Sahu, T. A., Pande, B., Pl, M., & Verma, H. K. (2022) · World Journal of Hepatology · doi:10.4254/wjh.v14.i6.1099 · Cited by 5
An international, multicenter, survey-based analysis of practice and management of acute liver failure
Gurakar, A. O., Conde, I., Öztürk, N. B., Artru, F., Selzner, N., Psoter, K. J., Dionne, J. C., Karvellas, C. J., Rajakumar, A., Saner, F. H., et al. (2024) · Liver Transplantation · doi:10.1097/lvt.0000000000000402 · Cited by 5
WHO’s misguided push for complementary and alternative medicine
Philips, C. A., Caulfield, T., de Jong, C., Qi, X., & Narayan, D. C. (2026) · BMJ · doi:10.1136/bmj-2026-100062 · Cited by 5
Kinsenoside derivatives mitigate acute liver injury in mice via MAPK pathway-mediated oxidative stress suppression
Zhang, B., Zhao, Z., Chen, X., Wang, F., Luo, Z., Gu, L., Tong, Q., & Zhang, Y. (2025) · Bioorganic Chemistry · doi:10.1016/j.bioorg.2025.108840 · Cited by 4
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Identifying high-risk drugs and demographic patterns in drug-induced liver injury from FAERS and CVARD analyses
He, Y., Chen, X.-D., Wu, S., Zhou, C.-B., Wang, P., Tang, S., Sun, Y.-S., Zhang, C., Wang, B.-Z., Gao, C.-H., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-24262-7 · Cited by 4
The incidence of chronic drug-induced liver injury: a systematic review and meta-analysis
Zhang, Y., Ren, Y., Song, X.-R., He, X.-J., & Wen, X. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2026.1710414 · Cited by 4
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Anxiety and Its Influencing Factors in Patients With Drug-Induced Liver Injury
Liu, Y., Guo, Y. P., Xu, H., Feng, H., & Chen, D. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.889487 · Cited by 4
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Clinical and biochemical characteristics, and outcome in 33 patients with ceftriaxone-induced liver injury
Feng, C., Ye, W., & Shan, Q.-W. (2024) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-024-03701-w · Cited by 4
Comparison of the hepatoprotection of intragastric and intravenous cyanidin-3-glucoside administration: focus on the key metabolites and gut microbiota modulation
Wang, B., Tang, X., Mao, B., Zhang, Q., Tian, F., Zhao, J., Chen, W., & Cui, S. (2024) · Food & Function · doi:10.1039/d4fo01608d · Cited by 4
Incidence, clinical classification and risk factors of cyclosporin A‐induced liver injury in allogeneic haematopoietic stem cell transplant recipients
Lv, B., Wang, Y., Xu, X., Zheng, Y., Huang, M., Chen, X., Tang, K., Li, J., & Chen, P. (2024) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.16185 · Cited by 4
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Propensity score matching-based analysis of the effect of corticosteroids in treating severe drug-induced liver injury
Wu, H., Yan, W., Liu, K., Jing, J., & Ye, W. (2024) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2024.102472 · Cited by 4
Biochemical biomarkers for the toxicity induced by Traditional Chinese Medicine: A review update
Gu, X., Zou, Y., Huang, Z., Wei, M., & Ji, L. (2025) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2024.119315 · Cited by 4
Sodium alginate alleviated isoniazid-induced liver injury by modulating fecal metabolites and gut microbiota
Wang, X., Zhang, J., Xia, X., Fang, Y., Yang, L., Zhou, Y., Hu, S., Jiang, L., Xiong, K., & Wang, J. (2025) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2025.141149 · Cited by 4
Nanozymes: new strategy for the management drug-induced acute liver injury
Kan, M., Wang, Y., Cheng, N., Huang, K., & He, X. (2025) · Journal of Materials Chemistry B · doi:10.1039/d5tb00448a · Cited by 4
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A narrative review of herb-induced liver injury
Lee, T. (2021) · Digestive Medicine Research · doi:10.21037/dmr-21-8 · Cited by 4
Heme Oxygenase-1 and Hemopexin Gene Polymorphisms and the Risk of Anti-Tuberculosis Drug-Induced Hepatotoxicity in China
Liu, W., Lu, L., Pan, H., He, X., Zhang, M., Wang, N., Zhu, J. X., Yi, H., & Tang, S. (2022) · Pharmacogenomics · doi:10.2217/pgs-2022-0015 · Cited by 4
In silico prediction of drug‐induced liver injury with a complementary integration strategy based on hybrid representation
Gu, Y., Wang, Y., Wu, Z., Li, W., Liu, G., & Tang, Y. (2023) · Molecular Informatics · doi:10.1002/minf.202200284 · Cited by 4
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Targeted Therapy of Acute Liver Injury via Cryptotanshinone-Loaded Biomimetic Nanoparticles Derived from Mesenchymal Stromal Cells Driven by Homing
Zhang, X., Yao, Y., Jiang, Y., Liao, J., Yang, R., Deng, X., & Zhang, L. (2023) · Pharmaceutics · doi:10.3390/pharmaceutics15122764 · Cited by 4
Impact of corticosteroid doses on prognosis of severe and critical COVID-19 patients with Omicron variant infection: a propensity score matching study
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Authors: Shen, T., Liu, Y., Shang, J., Xie, Q., Li, J., Yan, M., Xu, J., Niu, J., Liu, J., Watkins, P. B., Aithal, G. P., Andrade, R. J., Dou, X., Yao, L., Lv, F., Wang, Q., Li, Y., Zhou, X., Zhang, Y., Zong, P., Wan, B., Zou, Z., Yang, D., Nie, Y., Li, D., Wang, Y., Han, X., Zhuang, H., Mao, Y., & Chen, C.
Affiliations: Peking University (CN)
Shenzhen Third People’s Hospital (CN)
Henan Provincial People's Hospital (CN)
Shanghai Jiao Tong University (CN)
Jiangsu Province Hospital (CN)
Qilu Hospital of Shandong University (CN)
First Affiliated Hospital of Anhui Medical University (CN)
First Hospital of Jilin University (CN)
First Affiliated Hospital of Xiamen University (CN)
University of North Carolina at Chapel Hill (US)
Nottingham University Hospitals NHS Trust (GB)
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES)
China Medical University (CN)
Fujian Medical University (CN)
Sir Run Run Shaw Hospital (CN)
Shanxi Medical University (CN)
Harbin Medical University (CN)
Xijing Hospital (CN)
Xinjiang Medical University (CN)
Jiangxi Chest Hospital (CN)
Public Health Clinical Center of Chengdu (CN)
302 Military Hospital of China (CN)
Wuhan Union Hospital (CN)
Guangzhou First People's Hospital (CN)
Fuzhou General Hospital of Nanjing Military Command (CN)
Corresponding author: Mao, Yimin
Chen, Chengwei
ORCID: Shen, Tao
Liu, Yingxia
Shang, Jia
Xie, Qing
Li, Jun
Yan, Ming
Xu, Jianming
Niu, Junqi
Liu, Jiajun
Watkins, Paul B.
Aithal, Guruprasad P.
Andrade, Raúl J.
Dou, Xiaoguang
Yao, Lvfeng
Lv, Fangfang
Wang, Qi
Li, Yongguo
Zhou, Xinmin
Zhang, Yuexin
Wan, Bin
Zou, Zhengsheng
Yang, Dongliang
Nie, Yuqiang
Li, Dongliang
Wang, Yuya
Zhuang, Hui
Mao, Yimin
Chen, Chengwei
Venue: Gastroenterology
Publisher: Elsevier BV
Published: 2019-06
Volume: 156
Issue: 8
Pages: 2230-2241.e11
ISSN: 0016-5085 (ISSN-L)
DOI: 10.1053/j.gastro.2019.02.002
OpenAlex: W2914750127
Cited by: 615
References: 43
Citations by year: 2026: 66 · 2025: 89 · 2024: 95 · 2023: 84 · 2022: 91 · 2021: 82 · 2020: 67 · 2019: 41
FWCI: 45.62
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
Locations: Gastroenterology (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
Repository@Nottingham (University of Nottingham) (acceptedVersion, cc-by-nc-nd)
Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc-nd)
Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion, cc-by-nc-nd)
RISalud Institutional Health Repository of Andalucía (submittedVersion, cc-by-nc-nd)
UNC Libraries
Funders: Shanghai Shenkang Hospital Development Center (16CR2009A)
School of Medicine, Shanghai Jiao Tong University (DLY201607)
National Natural Science Foundation of China (81670524)
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 › Hepatology › Liver physiology and pathology
Keywords: drug-induced liver injury, incidence, etiology, hepatocyte injury, cholestatic liver injury, traditional Chinese medicine, herbal and dietary supplements, antitubercular agents, liver failure, liver transplantation, Hy's law, RUCAM, hospitalized patients, China, pharmacovigilance, incidence estimation
MeSH terms: Acute Disease, Adult, Aged, Cause of Death, China, Chronic Disease, Female, Humans, Liver Function Tests, Male, Middle Aged, Registries, Retrospective Studies, Severity of Illness Index, Cohort Studies, Incidence, Survival Rate, Confidence Intervals, Liver Failure, Acute, Age Distribution, Sex Distribution, Risk Assessment, Young Adult, Chemical and Drug Induced Liver Injury, End Stage Liver Disease

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Incidence and Etiology of Drug-Induced Liver Injury in Mainland China

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