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Drug-induced liver injury: a comprehensive review
Abstract
Drug-induced liver injury (DILI) remains a challenge in clinical practice and is still a diagnosis of exclusion. Although it has a low incidence amongst the general population, DILI accounts for most cases of acute liver failure with a fatality rate of up to 50%. While multiple mechanisms of DILI have been postulated, there is no clear causal relationship between drugs, risk factors and mechanisms of DILI. Current best practice relies on a combination of high clinical suspicion, thorough clinical history of risk factors and timeline, and extensive hepatological investigations as supported by the international Roussel Uclaf Causality Assessment Method criteria, the latter considered a key diagnostic algorithm for DILI. This review focuses on DILI classification, risk factors, clinical evaluation, future biomarkers and management, with the aim of facilitating physicians to correctly identify DILI early in presentation.
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RUCAM is considered a key diagnostic tool for DILI.
“These are guided by the standards of the internationally recognized Roussel Uclaf Causality Assessment Method, which is considered a key diagnostic tool for DILI [11].”
From Metabolomic Analysis of Pediatric Patients with Idiosyncratic Drug-Induced Liver Injury According to the Updated RUCAM (2023) · cites this paper as [11]
DILI accounts for approximately 10-15% of acute liver failure cases.
“DILI accounts for approximately 10–15% of the cases of acute liver failure (ALF) and presents a major challenge for drug safety and development.[1]”
From Drug-induced liver injury: Diagnosis, management and the role of liver transplantation (2025) · cites this paper as [1]
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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
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Drug induced liver injury – a 2023 update
Allison, R., Guraka, A., Shawa, I. T., Tripathi, G., Moritz, W., & Kermanizadeh, A. (2023) · Journal of Toxicology and Environmental Health, Part B · doi:10.1080/10937404.2023.2261848 · Cited by 167
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Drug-induced liver injury: Diagnosis, management and the role of liver transplantation
Ozturk, N. B., Uskudar, E., Toruner, M. D., Simsek, C., & Gurakar, A. (2025) · Hepatology Forum · doi:10.14744/hf.2024.2024.0003 · Cited by 9
Suenghataiphorn, T., Danpanichkul, P., Tribuddharat, N., & Kulthamrongsri, N. (2025) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2025.102627 · Cited by 6
Metadata
- Authors
- Hosack, T., Damry, D., & Biswas, S.
- Venue
- Therapeutic Advances in Gastroenterology
- Publisher
- SAGE Publications
- Published
- 2023-01
- Volume
- 16
- ISSN
- 1756-2848
- PMC
- PMC10031606
- Cited by
- 214
- References
- 8
- Language
- en
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