The diagnosis and management of idiosyncratic drug‐induced liver injury

Drug‐induced liver injury (DILI) is an uncommon but important cause of liver disease that can arise after exposure to a multitude of drugs and herbal and dietary supplements. The severity of idiosyncratic DILI varies from mild serum aminotransferase elevations to the development of severe liver inju...

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Bibliographic Details
Published in:Liver international 2019-01, Vol.39 (1), p.31-41
Main Authors: Hassan, Ammar, Fontana, Robert J.
Format: Article
Language:English
Subjects:
Acetylcysteine
Acetylcysteine - therapeutic use
acute liver failure
Adrenal Cortex Hormones - therapeutic use
Biomarkers
Biomarkers - analysis
Chemical and Drug Induced Liver Injury - diagnosis
Chemical and Drug Induced Liver Injury - therapy
Corticoids
Corticosteroids
Demographics
Diagnostic systems
Diet
Dietary supplements
drug‐induced liver injury
hepatotoxicity
Humans
Immunosuppressive agents
Injuries
Liver
Liver - chemistry
Liver - pathology
Liver diseases
Liver Failure, Acute - etiology
Liver Transplantation
Pathogenesis
Patients
Randomized Controlled Trials as Topic
Risk Factors
Transplantation
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Summary:Drug‐induced liver injury (DILI) is an uncommon but important cause of liver disease that can arise after exposure to a multitude of drugs and herbal and dietary supplements. The severity of idiosyncratic DILI varies from mild serum aminotransferase elevations to the development of severe liver injury that can progress to acute liver failure resulting in death or liver transplantation within days of DILI onset. Chronic liver injury that persists for more than 6 months after DILI onset is also becoming increasingly recognized in up to 20% of DILI patients. Host demographic (age, gender, race), clinical and laboratory features at DILI onset have been associated with the severity and outcome of liver injury in DILI patients. In addition to cessation of the suspect drug, other medical interventions including the use of N‐acetylcysteine and corticosteroids in selected patients have shown some clinical benefit, but additional prospective studies are needed. A number of promising diagnostic, prognostic and mechanistic serum and genetic biomarkers may help improve our understanding of the pathogenesis and treatment of idiosyncratic DILI.
ISSN:1478-3223
1478-3231
DOI:10.1111/liv.13931