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Semin Liver Dis 2019; 39(03): 381-394
DOI: 10.1055/s-0039-1685519
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Assessment of Serious Acute and Chronic Idiosyncratic Drug-Induced Liver Injury in Clinical Practice

Fernando Bessone   *
1   Hospital Provincial del Centenario, University of Rosario School of Medicine, Rosario, Argentina
,
Mercedes Robles-Diaz   *
2   Unidad de Gestión Clínica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Hospital Universitario Virgen de la Victoria, Málaga, Spain
3   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
,
Nelia Hernandez
4   Facultad de Medicina, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
,
Inmaculada Medina-Caliz
5   Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Hospital Universitario Virgen de la Victoria, Málaga, Spain
,
M. Isabel Lucena   #
3   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
5   Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Hospital Universitario Virgen de la Victoria, Málaga, Spain
6   Unidad Investigación Clínica y Ensayos Clínicos (UICEC)-IBIMA, Plataforma Spanish Clinical Research Network (SCReN), Málaga, Spain
,
Raul J. Andrade   #
2   Unidad de Gestión Clínica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Hospital Universitario Virgen de la Victoria, Málaga, Spain
3   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
› Author Affiliations Funding This study has been supported by grants from the Instituto de Salud Carlos III cofounded by Fondo Europeo de Desarrollo Regional – FEDER (contract numbers: PI15/01440, PT17/0017/0020) and by the Agencia Española del Medicamento. M. R. D. holds a “Joan Rodes” research contract from the National System of Health, ISCIII (JR16/00015). SCReN and CIBERehd are funded by Instituto de Salud Carlos III.
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Publication History

Publication Date:
02 May 2019 (online)

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Abstract

Drug-induced liver injury (DILI) is the leading cause of acute liver failure (ALF) in developed countries. The extremely variable phenotype of DILI, both in presentation and in severity, is one of the distinctive characteristics of the disease and one of the major challenges that hepatologists face when assessing hepatotoxicity cases. A new Hy's law that more accurately predicts the risk of ALF related to DILI has been proposed and validated. Other prognostic scoring algorithms for the early identification of DILI patients who may go on to develop ALF have been developed as it is of most clinical relevance to stratify patients for closer monitoring. Recent data indicate that acute DILI often presents a more prolonged resolution or evolves into chronicity at a higher frequency than other forms of acute liver injury. Risk factors for chronicity, specific phenotypes, and histological features are discussed in this study. Biomarkers to predict DILI outcome are in need.

Keywords

hepatotoxicity - acute liver failure - chronic DILI - risk factors - histopathology

* FB and MRD contributed equally to this work.


# MIL and RJA share senior authorship.


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