Drug induced liver injury classification: Difference between revisions
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===Clinical presentation:=== | ===Clinical presentation:=== | ||
====Hepatocellular injury==== | ====Hepatocellular injury==== | ||
*elevation of serum transaminases | *elevation of serum transaminases ≥ 2-5 times the upper limit of normal | ||
*may have hyperbilirubinemia | *may have hyperbilirubinemia | ||
*may have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin) | *may have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin) | ||
====Cholestatic injury==== | ====Cholestatic injury==== | ||
*elevation of alkaline phosphatase | *elevation of alkaline phosphatase ≥ 3 times the upper limit of normal | ||
*may have hyperbilirubinemia | *may have hyperbilirubinemia | ||
*may have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin) | *may have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin) | ||
Revision as of 20:51, 19 October 2016
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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
There are various classification systems in place for drug induced liver injury.[1]
Classification
Drug induced liver injury may be classified into multiple subtypes based on clinical presentation, mechanism, or histologic findings.
Clinical presentation:
Hepatocellular injury
- elevation of serum transaminases ≥ 2-5 times the upper limit of normal
- may have hyperbilirubinemia
- may have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin)
Cholestatic injury
- elevation of alkaline phosphatase ≥ 3 times the upper limit of normal
- may have hyperbilirubinemia
- may have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin)
Mixed injury
- both alkaline phosphatase and transaminases are elevated in roughly equal proportion, and/or an alanine aminotransferase to alkaline phosphatase ratio between 2-5
Mechanism:
Dose-dependent hepatotoxicity
- e.g. acetaminophen-induced centrilobular necrosis
Idiosyncratic hepatotoxicity
- e.g. stimulation of immune reponse by biologic agents, independent of dose, akin to drug hypersensitivity
- e.g. altered host genes involved in drug metabolism
Histologic findings:
Hepatitis (hepatocellular injury)
Cholestasis
Granulomatous
Steatosis
Fibrosis
References
- ↑ Fisher K, Vuppalanchi R, Saxena R (2015). "Drug-Induced Liver Injury". Arch Pathol Lab Med. 139 (7): 876–87. doi:10.5858/arpa.2014-0214-RA. PMID 26125428.