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Cited by 9Drug-Induced Hepatotoxicity and ProtectionLiver physiology and pathologyLiver Disease Diagnosis and Treatment

The DOI matches its Crossref record; 38 of the 39 references it cites were found in a registry or an index, and 1 are not checked yet; 4 of the 66 sources its claims cite were checked for support.

Drug-induced liver injury: Diagnosis, management and the role of liver transplantation

Open access
Ozturk, Nazli Begum, Uskudar, Eren, Toruner, Merih Deniz, Simsek, Cem, Gurakar, Ahmet·2025·Hepatology Forum
DOI 10.14744/hf.2024.2024.0003PMC PMC11999897
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Abstract

Drug-induced liver injury (DILI) is caused by various medications or herbals/nutritional supplements resulting in liver test abnormalities or hepatic dysfunction. DILI can be categorized as direct (intrinsic), idiosyncratic, or immune-mediated (indirect), and patterns of injury can be categorized as hepatocellular, cholestatic, or mixed injury. DILI is diagnosed after excluding other causes of liver injury. Cessation of the suspected drug along with supportive care is recommended for most DILI cases. In life-threatening situations, liver transplantation (LT) can be considered; however, the risks with LT and life-long immunosuppression should be considered. In this paper, we summarize the pathophysiology, diagnosis, medical management, and LT for DILI.

Verified 2026-11-10 · 1 reference not checked yet

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

Drug-induced liver injury (DILI) is a variable liver injury from medications or herbals/dietary supplements, diagnosed mainly by excluding other causes and managed by stopping the suspected agent with supportive care. This narrative review summarizes DILI pathophysiology, diagnosis, medical management, and liver transplantation (LT), noting a reported 10% mortality rate and that LT is reserved for life-threatening or progressive disease.

Key findings

  • DILI accounts for approximately 10–15% of acute liver failure (ALF) cases; overall mortality is reported at 10%.
  • Idiosyncratic DILI is rare, reported in 1 to 1,000–1,000,000 people; about 80% resolve without long-term sequelae, while 10% are at risk of severe adverse hepatic outcomes including ALF and need for LT.
  • In idiosyncratic DILI with ALF, transplant-free survival at 3 weeks is 23.5%–38.7%, and spontaneous survival without LT is 25%; emergency LT offers a 3-week survival benefit of 88%.
  • Hospitalized DILI patients with coagulopathy and hepatic encephalopathy have a likelihood of spontaneous recovery <30% and should promptly be considered for LT evaluation; in a European registry over 20 years, 18% of LTs for ALF were due to DILI.

Methods

  • Narrative review summarizing the pathophysiology, diagnosis, medical management, and role of LT in DILI.
  • No systematic review methods, search strategy, inclusion criteria, or primary data collection are described in the paper.
  • Evidence is drawn from cited literature, registries, and observational/randomized studies, including DILIN, the US Acute Liver Failure Study Group, and the European Liver Transplantation Registry.

Limitations

  • Stated: lack of a specific diagnostic tool for DILI; lack of consensus on which causality assessment method is superior; scarce data and no randomized controlled trials on corticosteroid efficacy/safety in DILI; no clear evidence-based recommendation for corticosteroid indication, dose, or duration; lack of large randomized controlled trials for optimal ursodeoxycholic acid dose and duration.
  • Evident: as a narrative review without a described systematic search or formal quality appraisal, conclusions depend on heterogeneous cited studies and registry data.

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

Integrity signals

Registry

Crossref · 10.14744/hf.2024.2024.0003

Cites

38 of 39 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

4 of 66 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    In that Chinese study, of those with ALF, 102 (0.30%) died.

    “In an observational retrospective study from China conducted between 2012–2014, out of 25,927 patients, 280 (1.08%) patients developed ALF, and of those with ALF, 2 patients (0.01%) underwent LT and 102 (0.30%) died (10).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] Shen T Liu Y Shang J Xie Q Li J Yan M Incidence and Etiology of Drug-Induced Liver Injury in Mainland China Gastroenterology 2019 156 8 2230 2241.e11 10.1053/j.gastro.2019.02.002 30742832 source

      The Results (accepted manuscript; page not provided) report 102 deaths, but give the rate as 0.39% of DILI cases, not 0.30%. They list 280 cases progressing to hepatic failure separately from the deaths; the source does not say that all 102 deaths occurred among those 280 patients. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    In that Chinese study, DILI was the main reason for death in 52 (70.59%) of the patients.

    “In this study, ALF was defined as INR ≥2, the presence of HE, total bilirubin ≥10 times upper limit of normal or daily elevations ≥1 mg/dL, and the disease duration of <26 weeks, and DILI was the main reason for death in 52 (70.59%) of the patients.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] Shen T Liu Y Shang J Xie Q Li J Yan M Incidence and Etiology of Drug-Induced Liver Injury in Mainland China Gastroenterology 2019 156 8 2230 2241.e11 10.1053/j.gastro.2019.02.002 30742832 source

      The Abstract reports that DILI had a primary role in 72 deaths (70.59%), not 52. The percentage and the characterization of DILI as the main reason for death are supported, but the count is not. (LLM, conf=0.92)

      Experimental — accuracy not yet measured
  • Premisecitation

    Serum APAP level after a single-time-point acute ingestion can aid in identifying patients with the highest risk of developing liver injury.

    “Serum APAP level after a single-time-point acute ingestion can aid in identifying patients with the highest risk of developing liver injury, and the use of the modified Rumack-Matthew nomogram is recommended in patients with single-point APAP ingestion to guide N-acetylcysteine (NAC) therapy.[2]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] Fontana RJ Liou I Reuben A Suzuki A Fiel MI Lee W AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury Hepatology 2023 77 3 1036 1065 10.1002/hep.32689 35899384 PMC9936988 source
  • Premisecitation

    Patients with ALF due to idiosyncratic DILI have a 25% chance of spontaneous survival without LT.

    “Patients with ALF due to idiosyncratic DILI have a 25% chance of spontaneous survival without LT, and early transfer to an LT center is critical for these patients.[11]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Ozturk NB Herdan E Saner FH Gurakar A A Comprehensive review of the diagnosis and management of acute liver failure J Clin Med 2023 12 23 7451 10.3390/jcm12237451 38068503 PMC10707329
  • Premisecitation

    If patients with APAP hepatotoxicity progress to ALF, approximately one-third require LT or die.

    “However, if patients progress to ALF, approximately one-third of the patients require LT or die.[2]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Fontana RJ Liou I Reuben A Suzuki A Fiel MI Lee W AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury Hepatology 2023 77 3 1036 1065 10.1002/hep.32689 35899384 PMC9936988 source
  • It may state two separate claims as one. 15
  • Probably not a substantial claim. 9

  • It may state two separate claims as one.

    Premisecitation

    Idiosyncratic hepatotoxicity is rare, largely dose-independent, unpredictable, and has variable latency.

    “Idiosyncratic hepatotoxicity is rare, largely dose-independent, unpredictable, and has variable latency.[2]”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [2] Fontana RJ Liou I Reuben A Suzuki A Fiel MI Lee W AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury Hepatology 2023 77 3 1036 1065 10.1002/hep.32689 35899384 PMC9936988 source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    HDS account for approximately 20% of all liver injury cases in the US based on DILIN Registry data.

    “HDS account for approximately 20% of all liver injury cases in the US based on Drug-Induced Liver Injury Network (DILIN) Registry data.[15]”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] Navarro VJ Barnhart H Bonkovsky HL Davern T Fontana RJ Grant L Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network 2014 Hepatology 60 4 1399 1408 10.1002/hep.27317 PMC4293199 25043597 source

      The Results (Temporal Trends in Liver Injury) report that HDS accounted for 20% of DILIN cases in the later enrollment period, not across the entire registry; the Abstract (Rationale) gives 15.5% for the full study sample. The Discussion says DILIN is not population-based, so these figures do not establish a share of all liver injury cases in the US. (LLM, conf=0.91)

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Premisecitation

    Idiosyncratic DILI is characterized by variable drug latency, clinical presentation, and liver histopathology findings, and is thought to be due to an aberrant host immune response to the drugs.

    “It is characterized by variable drug latency, clinical presentation, and liver histopathology findings, and is thought to be due to an aberrant host immune response to the drugs.[2]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Fontana RJ Liou I Reuben A Suzuki A Fiel MI Lee W AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury Hepatology 2023 77 3 1036 1065 10.1002/hep.32689 35899384 PMC9936988 source

  • It may state two separate claims as one.

    Premisecitation

    Data on corticosteroid use in DILI is scarce with no randomized controlled studies to evaluate their efficacy and safety.

    “Data on corticosteroid use in DILI is scarce with no randomized controlled studies to evaluate their efficacy and safety; however, there are reports of corticosteroids having beneficial effects in patients with moderate or severe DILI.[18,23]”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [18] Chalasani NP Maddur H Russo MW Wong RJ Reddy KR Practice Parameters Committee of the American College of Gastroenterology ACG Clinical Guideline: Diagnosis and management of idiosyncratic drug-induced liver injury Am J Gastroenterol 2021 116 5 878 898 10.14309/ajg.0000000000001259 33929376 source
    • cites [23] Björnsson ES Vucic V Stirnimann G Robles-Díaz M Role of corticosteroids in drug-induced liver injury. A systematic review Front Pharmacol 2022 13 820724 10.3389/fphar.2022.820724 35222034 PMC8867035

  • It may state two separate claims as one.

    Premisecitation

    APAP causes liver injury predictably and in a dose-related manner, typically with doses exceeding 4 g/day at a single time point or with excessive doses over several days/weeks.

    “APAP causes liver injury predictably and in a dose-related manner, typically with doses exceeding 4 g/day at a single time point or with excessive doses over several days/weeks.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Fontana RJ Liou I Reuben A Suzuki A Fiel MI Lee W AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury Hepatology 2023 77 3 1036 1065 10.1002/hep.32689 35899384 PMC9936988 source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Overall, a 10% mortality rate is reported for DILI.

    “Overall, a 10% mortality rate is reported for DILI.[25–27]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [25] Andrade RJ Lucena MI Fernández MC Pelaez G Pachkoria K García-Ruiz E Drug-induced liver injury: An analysis of 461 incidences submitted to the spanish registry over a 10-year period Gastroenterology 2005 129 2 512 521 10.1016/j.gastro.2005.05.006 16083708 source
    • cites [26] Hayashi PH Rockey DC Fontana RJ Tillmann HL Kaplowitz N Barnhart HX Death and liver transplantation within 2 years of onset of drug-induced liver injury Hepatology 2017 66 4 1275 1285 10.1002/hep.29283 28543844 PMC5605419 source
    • cites [27] Chalasani N Bonkovsky HL Fontana R Lee W Stolz A Talwalkar J Features and outcomes of 899 patients with drug-induced liver injury: The dilin prospective study Gastroenterology 2015 148 7 1340 1352.e7 25754159 PMC4446235

  • It may state two separate claims as one.

    Premisecitation

    In cases of APAP overdose, patients may initially be asymptomatic but can rapidly progress to liver failure within 3-4 days.

    “In cases of APAP overdose, patients may initially be asymptomatic but can rapidly progress to liver failure within 3–4 days.[12]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Devarbhavi H Dierkhising R Kremers WK Sandeep MS Karanth D Adarsh CK Single-center experience with drug-induced liver injury from India: causes, outcome, prognosis, and predictors of mortality Am J Gastroenterol 2010 105 11 2396 2404 10.1038/ajg.2010.287 20648003

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    HDS constitute the majority of idiosyncratic DILI in many Asian countries including China and Korea, while they are responsible for the minority of DILI cases in the United States.

    “HDS constitute the majority of the idiosyncratic DILI in many Asian countries including China and Korea, while they are responsible for the minority of DILI cases in the United States (US).[2,10,14]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [2] Fontana RJ Liou I Reuben A Suzuki A Fiel MI Lee W AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury Hepatology 2023 77 3 1036 1065 10.1002/hep.32689 35899384 PMC9936988 source
    • cites [10] Shen T Liu Y Shang J Xie Q Li J Yan M Incidence and Etiology of Drug-Induced Liver Injury in Mainland China Gastroenterology 2019 156 8 2230 2241.e11 10.1053/j.gastro.2019.02.002 30742832 source
    • cites [14] Takikawa H Murata Y Horiike N Fukui H Onji M Drug-induced liver injury in Japan: An analysis of 1676 cases between 1997 and 2006 Hepatol Res 2009 39 5 427 431 10.1111/j.1872-034X.2008.00486.x 19207579

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Most commonly implicated medications for idiosyncratic DILI are antimicrobials, immunomodulatory agents, and central nervous system agents.

    “Most commonly implicated medications for idiosyncratic DILI are antimicrobials, immunomodulatory agents, and central nervous system agents.[2,10,12,13]”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [2] Fontana RJ Liou I Reuben A Suzuki A Fiel MI Lee W AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury Hepatology 2023 77 3 1036 1065 10.1002/hep.32689 35899384 PMC9936988 source
    • cites [10] Shen T Liu Y Shang J Xie Q Li J Yan M Incidence and Etiology of Drug-Induced Liver Injury in Mainland China Gastroenterology 2019 156 8 2230 2241.e11 10.1053/j.gastro.2019.02.002 30742832 source
    • cites [12] Devarbhavi H Dierkhising R Kremers WK Sandeep MS Karanth D Adarsh CK Single-center experience with drug-induced liver injury from India: causes, outcome, prognosis, and predictors of mortality Am J Gastroenterol 2010 105 11 2396 2404 10.1038/ajg.2010.287 20648003
    • cites [13] Edwards D Lin C Lin J Oshima K King EA Wesson RN Delayed onset drug-induced acute liver failure associated with Glatiramer acetate use in multiple sclerosis requiring liver transplantation J Liv Transpl 2024 13 100201 10.1016/j.liver.2024.100201

  • It may state two separate claims as one.

    Premisecitation

    Most cases of DILI are diagnosed by excluding other causes of liver injury and by considering the temporal relationship of liver injury and initiation of the suspected drug.

    “Despite these tools, most cases of DILI are diagnosed by excluding other causes of liver injury and by considering the temporal relationship of liver injury and initiation of the suspected drug.[8]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Iorga A Dara L Kaplowitz N Drug-induced liver injury: Cascade of events leading to cell death, apoptosis or necrosis Int J Mol Sci 2017 18 5 1018 10.3390/ijms18051018 28486401 PMC5454931

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Idiosyncratic DILI is rare and reported to occur in 1 to 1,000-1,000,000 people.

    “Idiosyncratic DILI is rare and reported to occur in 1 to 1,000–1,000,000 people.[2]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Fontana RJ Liou I Reuben A Suzuki A Fiel MI Lee W AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury Hepatology 2023 77 3 1036 1065 10.1002/hep.32689 35899384 PMC9936988 source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Other medications/herbals/nutrients including aspirin, amiodarone, chemotherapeutic agents, paraquat, carbon tetrachloride, and mushroom poisons can also lead to DILI.

    “Other medications/herbals/nutrients including aspirin, amiodarone, chemotherapeutic agents, paraquat, carbon tetrachloride, and mushroom poisons can also lead to DILI.[9]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] McGill MR Jaeschke H Animal models of drug-induced liver injury Biochim Biophys Acta Mol Basis Dis 2019 1865 5 1031 1039 10.1016/j.bbadis.2018.08.037 31007174 PMC6478394

  • It may state two separate claims as one.

    Premisecitation

    Molecular mechanisms involved in DILI include mitochondrial dysfunction, increased reactive oxygen species generation, depletion of ATP, increased apoptosis and necrosis, altered bile acid homeostasis/bile duct injuries, and cell death by apoptosis or necrosis.

    “Molecular mechanisms involved in DILI include mitochondrial dysfunction, increased reactive oxygen species generation, depletion of ATP, increased apoptosis and necrosis, altered bile acid homeostasis/bile duct injuries, and, as a result, cell death by apoptosis or necrosis (Fig. 1). [6–8]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [6] Allison R Guraka A Shawa IT Tripathi G Moritz W Kermanizadeh A Drug induced liver injury-a 2023 update J Toxicol Environ Health B Crit Rev 2023 26 8 442 467 10.1080/10937404.2023.2261848 37786264 source
    • cites [7] Ye H Nelson LJ Moral MG del Martínez-Naves E Cubero FJ Dissecting the molecular pathophysiology of drug-induced liver injury World J Gastroenterol 2018 24 13 1373 10.3748/wjg.v24.i13.1373 29632419 PMC5889818
    • cites [8] Iorga A Dara L Kaplowitz N Drug-induced liver injury: Cascade of events leading to cell death, apoptosis or necrosis Int J Mol Sci 2017 18 5 1018 10.3390/ijms18051018 28486401 PMC5454931

  • It may state two separate claims as one.

    Premisecitation

    Another trial including 102 patients with DILI due to antituberculosis medications reported a shorter length of stay, but no survival benefit with NAC.

    “Another trial including 102 patients with DILI due to antituberculosis medications reported a shorter length of stay, but no survival benefit with NAC.[20]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Moosa MS Maartens G Gunter H Allie S Chughlay MF Setshedi M A Randomized controlled trial of intravenous n-acetylcysteine in the management of anti-tuberculosis drug-induced liver injury Clin Infect Dis 2021 73 9 e3377 e3383 10.1093/cid/ciaa1255 32845997

  • It may state two separate claims as one.

    Premisecitation

    Immune-mediated DILI is related to pharmacodynamic properties of the drug rather than direct or idiosyncratic liver injury, is not dose-related, but partially predictable, and arises when host immune system leads to liver injury following medication administration.

    “Immune-mediated DILI is related to the pharmacodynamic properties of the drug rather than direct or idiosyncratic liver injury, is not dose-related, but partially predictable, and arises when the host immune system leads to liver injury following medication administration.[3,5]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [3] Björnsson H Björnsson E Drug-induced liver injury: Pathogenesis, epidemiology, clinical features, and practical management European Journal of Internal Medicine 2022 97 26 31 10.1016/j.ejim.2021.10.035 34772600
    • cites [5] Gerussi A Natalini A Antonangeli F Mancuso C Agostinetto E Barisani D Immune-Mediated Drug-Induced Liver Injury: Immunogenetics and Experimental Models Int J Mol Sci 2021 22 9 4557 10.3390/ijms22094557 33925355 PMC8123708 source

  • It may state two separate claims as one.

    Premisecitation

    Amoxicillin-clavulanate is the most common medication implicated with idiosyncratic DILI in the US and Western countries, while anti-tuberculosis medications are the most commonly implicated medications in Asia, along with HDS.

    “Amoxicillin-clavulanate is the most common medication to be implicated with idiosyncratic DILI in the US and Western countries, while anti-tuberculosis medications are the most commonly implicated medications in Asia, along with HDS.[17]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Ahmad J Odin JA Epidemiology and genetic risk factors of drug hepatotoxicity Clin Liver Dis 2017 21 1 55 72 10.1016/j.cld.2016.08.004 27842775 PMC8290403

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In an observational retrospective study from China conducted between 2012-2014, out of 25,927 patients, 280 (1.08%) patients developed ALF.

    “In an observational retrospective study from China conducted between 2012–2014, out of 25,927 patients, 280 (1.08%) patients developed ALF, and of those with ALF, 2 patients (0.01%) underwent LT and 102 (0.30%) died (10).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Shen T Liu Y Shang J Xie Q Li J Yan M Incidence and Etiology of Drug-Induced Liver Injury in Mainland China Gastroenterology 2019 156 8 2230 2241.e11 10.1053/j.gastro.2019.02.002 30742832 source

  • It may state two separate claims as one.

    Premisecitation

    Ursodeoxycholic acid may improve pruritus and DILI recovery, but large randomized controlled trials are lacking for the optimal dose and duration.

    “Ursodeoxycholic acid may improve pruritus and DILI recovery, but large randomized controlled trials are lacking for the optimal dose and duration.[21]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Lang SM Ortmann J Rostig S Schiffl H Ursodeoxycholic acid attenuates hepatotoxicity of multidrug treatment of mycobacterial infections: A prospective pilot study Int J Mycobacteriol 2019 8 1 89 92 10.4103/ijmy.ijmy_159_18 30860185

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    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]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Hosack T Damry D Biswas S Drug-induced liver injury: a comprehensive review Therap Adv Gastroenterol 2023 Mar 21 16 17562848231163410 10.1177/17562848231163410 PMC10031606 36968618 source

  • It may state two separate claims as one.

    Premisecitation

    Direct hepatotoxicity is common, largely dose-dependent, predictable, and rapid in latency.

    “Direct hepatotoxicity is common, largely dose-dependent, predictable, and rapid in latency.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Fontana RJ Liou I Reuben A Suzuki A Fiel MI Lee W AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury Hepatology 2023 77 3 1036 1065 10.1002/hep.32689 35899384 PMC9936988 source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In the US, idiosyncratic DILI constitutes approximately 13% of all ALF cases.

    “In the US, idiosyncratic DILI constitutes approximately 13% of all ALF cases, with a 3-week transplant-free survival rate of 27%.[33]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Ostapowicz G Fontana RJ Schiødt FV Larson A Davern TJ Han SHB Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States Ann Intern Med 2002 137 12 947 954 10.7326/0003-4819-137-12-200212170-00007 12484709 source

  • It may state two separate claims as one.

    Premisecitation

    In the US, select patients with ALF are priority in the LT waitlist and given Status 1A priority if the life expectancy is <7 days without LT and no preexisting diagnosis liver disease is present.

    “In the US, select patients with ALF are priority in the LT waitlist and given Status 1A priority if the life expectancy is <7 days without LT and no preexisting diagnosis liver disease is present.[35,36]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [35] Liou IW Larson AM Role of liver transplantation in acute liver failure Semin Liver Dis 2008 28 2 201 209 10.1055/s-2008-1073119 18452119
    • cites [36] Pan JJ Fontana RJ CAQ Corner: Acute liver failure management and liver transplantation Liver Transpl 2022 28 10 1664 1673 10.1002/lt.26503 35574981 PMC9796044

  • It may state two separate claims as one.

    Interpretationnone given

    Clinical characteristics and presentation of DILI are variable, and a lack of a specific diagnostic tool presents a major challenge for diagnosis and management.

    “Clinical characteristics and presentation of DILI are variable, and a lack of a specific diagnostic tool presents a major challenge for diagnosis and management.”
    Quote in the paperSubstantial claim
23 of 23

  • The paper relies on this without support.

    APAP hepatotoxicity can be seen at lower doses in patients who are malnourished or those with alcohol-use disorder.

    “APAP hepatotoxicity can be seen at lower doses in patients who are malnourished or those with alcohol-use disorder.”

  • The paper relies on this without support.

    APAP hepatotoxicity often presents with very high transaminase levels, relatively low bilirubin levels, and elevated INR.

    “APAP hepatotoxicity often presents with very high transaminase levels, relatively low bilirubin levels, and elevated INR.”

  • The paper relies on this without support.

    NAC is the only effective antidote for severe hepatic necrosis due to APAP overdose.

    “NAC is the only effective antidote for severe hepatic necrosis due to APAP overdose.”

  • The paper relies on this without support.

    With advances in intensive care, especially in the past 2 decades, the outcomes of patients with APAP hepatotoxicity have improved.

    “With advances in intensive care, especially in the past 2 decades, the outcomes of patients with APAP hepatotoxicity have improved.”

  • The paper relies on this without support.

    There is a lack of consensus in the literature regarding which method of causality assessment is superior.

    “However, there is a lack of consensus in the literature regarding which method of causality assessment is superior.”

  • The paper relies on this without support.

    Corticosteroid therapy may be effective in cases with hypersensitivity or autoimmune features.

    “Corticosteroid therapy may be effective in cases with hypersensitivity or autoimmune features.”

  • The paper relies on this without support.

    The majority of patients with DILI recover spontaneously without treatment as reported in several studies.

    “Despite this, the majority of patients with DILI recover spontaneously without treatment as reported in several studies.”
7 of 7

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Reported death percentage does not match the cohort size

    Minor

    Of 25,927 patients, 102 deaths represent about 0.39%, not 0.30%.

    Reported 0.3 · recomputed 0.393412

  • Percentage attributed to DILI does not match the reported deaths

    Minor

    The text reports 102 deaths, but 52 of 102 is about 50.98%, not 70.59%.

    Reported 70.59 · recomputed 50.980392

2 of 2

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Metadata

Authors
Ozturk, N. B., Uskudar, E., Toruner, M. D., Simsek, C., & Gurakar, A.
Affiliations
  • Department of Internal Medicine, Beaumont Hospital, Michigan, USA
  • Johns Hopkins University (US)
  • Brown University (US)
  • Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Corresponding author
Gurakar, Ahmet
ORCID
Venue
Hepatology Forum
Publisher
Kare Publishing
Published
2025
Volume
6
Issue
2
Pages
72-76
ISSN
  • 1307-5888 (ISSN-L)
  • 2757-7392
DOI
10.14744/hf.2024.2024.0003
PMC
PMC11999897
OpenAlex
W4402447151
Semantic Scholar
136527b93c98b7212868d600a1c045dc96e2fcda
Cited by
9
References
38
Citations by year
2026: 8 · 2025: 1
FWCI
0.53
Type
journal article
Language
en
Open access
Locations
  • Hepatology forum/Hepatology forum (Online) (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
  • Health Sciences › Medicine › Hepatology › Liver physiology and pathology
  • Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
Keywords
drug-induced liver injury, liver transplantation, idiosyncratic drug reactions, immune-mediated liver injury, hepatocyte injury, cholestatic liver injury, immunosuppression

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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