Drug induced liver injury natural history, complications and prognosis
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Differentiating Drug Induced Liver Injury from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rachita Navara, M.D. [2]
Overview
The clinical course of drug induced liver injury varies based on causative drug.[1] There is a hallmark latent period between the initiation of the drug ("the challenge") and the development of either symptoms or, more commonly, asymptomatic elevations in serum alanine aminotransferase. Liver injury typically recurs if the drug is reintroduced in the future, often with greater severity that could be life-threatening. Prompt withdrawal of the offending drug leads to complete resolution in 90% of patients, with no long-term sequelae.
Natural History
There is a hallmark latent period between the initiation of the drug ("the challenge") and the development of either symptoms or, more commonly, asymptomatic elevations in serum alanine aminotransferase. Once the diagnosis of drug induced liver injury is established and the inciting drug is withdrawn, the "dechallenge" or clinical improvement is relatively immediate. Liver injury typically recurs if the drug is reintroduced in the future, often with greater severity that could be life-threatening.
Complications
The main complication that can develop as a result of drug induced liver injury is chronic liver failure in 5-10% of patients, particularly if they have preexisting liver disease. Up to 10% of patients with drug induced liver injury do not survive the initial injury or require liver transplantation. Overall, complications are dependent on the inciting drug and patient risk factors.
Prognosis
Prompt withdrawal of the offending drug leads to complete resolution in 90% of patients, with no long-term sequelae.
References
- ↑ Hayashi PH, Fontana RJ (2014). "Clinical features, diagnosis, and natural history of drug-induced liver injury". Semin Liver Dis. 34 (2): 134–44. doi:10.1055/s-0034-1375955. PMID 24879979.