Chinese Guideline for the Diagnosis and Treatment of Drug-induced Liver Injury: an Update

Overview

Journal Hepatol Int

Publisher Springer

Specialty Gastroenterology

Date 2024 Feb 24

PMID 38402364

Authors

Yimin Mao

Shiwu Ma

Chenghai Liu

Xiaoyan Liu

Minghua Su

Dongliang Li

Yiling Li

Gongying Chen

Jun Chen

Jinjun Chen

Jingmin Zhao

Xiaoyan Guo

Jieting Tang

Yuzheng Zhuge

Qing Xie

Wen Xie

Rongtao Lai

Dachuan Cai

Qingxian Cai

Yang Zhi

Xiaoyun Li

Affiliations

Soon will be listed here.

Abstract

Drug-induced liver injury (DILI) is an important adverse drug reaction that can lead to acute liver failure or even death in severe cases. Currently, the diagnosis of DILI still follows the strategy of exclusion. Therefore, a detailed history taking and a thorough and careful exclusion of other potential causes of liver injury is the key to correct diagnosis. This guideline was developed based on evidence-based medicine provided by the latest research advances and aims to provide professional guidance to clinicians on how to identify suspected DILI timely and standardize the diagnosis and management in clinical practice. Based on the clinical settings in China, the guideline also specifically focused on DILI in chronic liver disease, drug-induced viral hepatitis reactivation, common causing agents of DILI (herbal and dietary supplements, anti-tuberculosis drugs, and antineoplastic drugs), and signal of DILI in clinical trials and its assessment.

Citing Articles

Hepatotoxicity induced by arsenic trioxide: clinical features, mechanisms, preventive and potential therapeutic strategies.

Wen J, Li A, Wang Z, Guo X, Zhang G, Litzow M Front Pharmacol. 2025; 16:1536388.

PMID: 40051569 PMC: 11882591. DOI: 10.3389/fphar.2025.1536388.

Excessive glutathione intake contributes to chemotherapy resistance in breast cancer: a propensity score matching analysis.

Zhang Z, Gao J, Jia L, Kong S, Zhai M, Wang S World J Surg Oncol. 2024; 22(1):345.

PMID: 39709466 PMC: 11663319. DOI: 10.1186/s12957-024-03626-9.

Paclitaxel-Induced Hepatotoxicity in Ovarian Cancer Patients: A Case Report.

Yang H, Shen L, Yang Y, Li X J Investig Med High Impact Case Rep. 2024; 12():23247096241281603.

PMID: 39305219 PMC: 11418365. DOI: 10.1177/23247096241281603.

Role of liver biopsy in the management of idiosyncratic DILI.

Kleiner D Liver Int. 2024; 45(3):e16097.

PMID: 39254214 PMC: 11815619. DOI: 10.1111/liv.16097.

Methods for causality assessment of idiosyncratic drug-induced liver injury.

Garcia-Cortes M, Matilla-Cabello G, Lucena M Liver Int. 2024; 45(3):e16083.

PMID: 39166347 PMC: 11815608. DOI: 10.1111/liv.16083.

References

Li X, Tang J, Mao Y . Incidence and risk factors of drug-induced liver injury. Liver Int. 2022; 42(9):1999-2014. DOI: 10.1111/liv.15262. View

Sgro C, Clinard F, Ouazir K, Chanay H, Allard C, Guilleminet C . Incidence of drug-induced hepatic injuries: a French population-based study. Hepatology. 2002; 36(2):451-5. DOI: 10.1053/jhep.2002.34857. View

Bjornsson E, Bergmann O, Bjornsson H, Kvaran R, Olafsson S . Incidence, presentation, and outcomes in patients with drug-induced liver injury in the general population of Iceland. Gastroenterology. 2013; 144(7):1419-25, 1425.e1-3. DOI: 10.1053/j.gastro.2013.02.006. View

De Valle M, Av Klinteberg V, Alem N, Olsson R, Bjornsson E . Drug-induced liver injury in a Swedish University hospital out-patient hepatology clinic. Aliment Pharmacol Ther. 2006; 24(8):1187-95. DOI: 10.1111/j.1365-2036.2006.03117.x. View

Andrade R, Lucena M, Fernandez M, Pelaez G, Pachkoria K, Garcia-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):512-21. DOI: 10.1016/j.gastro.2005.05.006. View

Vega M, Verma M, Beswick D, Bey S, Hossack J, Merriman N . 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. 2017; 40(9):783-787. PMC: 5699929. DOI: 10.1007/s40264-017-0547-9. View

Suk K, Kim D, Kim C, Park S, Yoon J, Kim Y . A prospective nationwide study of drug-induced liver injury in Korea. Am J Gastroenterol. 2012; 107(9):1380-7. DOI: 10.1038/ajg.2012.138. View

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. DOI: 10.1053/j.gastro.2019.02.002. View

Vuppalanchi R, Liangpunsakul S, Chalasani N . Etiology of new-onset jaundice: how often is it caused by idiosyncratic drug-induced liver injury in the United States?. Am J Gastroenterol. 2006; 102(3):558-62. DOI: 10.1111/j.1572-0241.2006.01019.x. View

10.

Breu A, Patwardhan V, Nayor J, Ringwala J, DeVore Z, Ganatra R . A Multicenter Study Into Causes of Severe Acute Liver Injury. Clin Gastroenterol Hepatol. 2018; 17(6):1201-1203. DOI: 10.1016/j.cgh.2018.08.016. View

11.

Chang B, Li B, Huang A, Sun Y, Teng G, Wang X . Changes of four common non-infectious liver diseases for the hospitalized patients in Beijing 302 hospital from 2002 to 2013. Alcohol. 2016; 54:61-5. DOI: 10.1016/j.alcohol.2016.07.001. View

12.

Tujios S, Lee W . Acute liver failure induced by idiosyncratic reaction to drugs: Challenges in diagnosis and therapy. Liver Int. 2017; 38(1):6-14. PMC: 5741491. DOI: 10.1111/liv.13535. View

13.

Low E, Zheng Q, Chan E, Lim S . Drug induced liver injury: East versus West - a systematic review and meta-analysis. Clin Mol Hepatol. 2019; 26(2):142-154. PMC: 7160354. DOI: 10.3350/cmh.2019.1003. View

14.

Chirapongsathorn S, Sukeepaisarnjaroen W, Treeprasertsuk S, Chaiteerakij R, Surawongsin P, Hongthanakorn C . Characteristics of Drug-induced Liver Injury in Chronic Liver Disease: Results from the Thai Association for the Study of the Liver (THASL) DILI Registry. J Clin Transl Hepatol. 2022; 11(1):88-96. PMC: 9647102. DOI: 10.14218/JCTH.2021.00479. View

15.

Teo D, Ng P, Tan S, Lim A, Toh D, Chan S . Drug-induced liver injury associated with Complementary and Alternative Medicine: a review of adverse event reports in an Asian community from 2009 to 2014. BMC Complement Altern Med. 2016; 16:192. PMC: 4937524. DOI: 10.1186/s12906-016-1168-z. View

16.

Huang Y, Tseng S, Chen W, Chang T, Peng C, Lo G . Clinical characteristics and outcomes of drug-induced liver injury in Taiwan: With emphasis on the impact of chronic hepatitis B infection. J Chin Med Assoc. 2021; 85(3):286-294. DOI: 10.1097/JCMA.0000000000000648. View

17.

Devarbhavi H, Joseph T, Sunil Kumar N, Rathi C, Thomas V, Singh S . The Indian Network of Drug-Induced Liver Injury: Etiology, Clinical Features, Outcome and Prognostic Markers in 1288 Patients. J Clin Exp Hepatol. 2021; 11(3):288-298. PMC: 8103312. DOI: 10.1016/j.jceh.2020.11.002. View

18.

Chalasani N, Bonkovsky H, 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):1340-52.e7. PMC: 4446235. DOI: 10.1053/j.gastro.2015.03.006. View

19.

Hoofnagle J, Bjornsson E . Drug-Induced Liver Injury - Types and Phenotypes. N Engl J Med. 2019; 381(3):264-273. DOI: 10.1056/NEJMra1816149. View

20.

Aithal G, Watkins P, Andrade R, Larrey D, Molokhia M, Takikawa H . Case definition and phenotype standardization in drug-induced liver injury. Clin Pharmacol Ther. 2011; 89(6):806-15. DOI: 10.1038/clpt.2011.58. View