CLINICAL HEPATOLOGY UPDATE : Drug-induced Liver Injury

Drug-induced liver injury (DILI) is defined as a liver injury induced by drugs or herbal medicines leading to liver function test (LFT) abnormalities or hepatic dysfunction with reasonable exclusion of other competing etiologies. Globally, annual incidence of DILI is as high as 14 per 100,000 population and DILI can occur from 1/10,000 to 1/100,000 of those exposed to the drug. In Korea, the annual incidence of cases hostpialized at university-affiliated hospital is 12/100,000 persons/year. Reactive metabolites, genetic factors and environmental factors appear to play a key role in development of DILI. Most cases of DILI are related to idiosyncratic reactions (> 90%). Patients who suffer from DILI have a wide variety of clinical presentations ranging from subclinical LFT abnormalities to acute liver failure, liver cirrhosis or hepatic neoplasia. The diagnosis of DILI can be difficult since drug history is not always reliable and the relationship between exposure to the drug and hepatotoxicity is not always clear. There is no gold standard and no specific biomarker or characteristic histological feature that reliably identifies a drug as a cause of hepatotoxicity. Although several scale systems (e.g. The Counsil for International Organization of Medical Sciences [CIOMS]/ Roussel Uclaf Causality Assessment Method [RUCAM] criteria and Maria & Victorino clinical scale) were developed to guide the diagnosis of DILI, but unfortunately they fail to address all risk factors in all patients and none of those scales are used routinely in clinical practice. The most important aspect of management is early recognition and discontinuation of a putative offending agent.