Drug induced liver injury laboratory findings

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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

Laboratory tests help assess the severity of illness as well as help distinguish drug induced liver injury from other pathologies (see also: [Diagnosis]). Patterns of abnormalities can also distinguish between hepatocellular and cholestatic liver injury.

Laboratory Findings

The following laboratory tests should be obtained in all cases of suspected drug induced liver injury:

• CBC with differential: may reveal eosinophilia in hypersensitivity reactions e.g. DRESS, or lymphocytosis (with atypical lymphocytes on smear) in mononucleosis-like illnesses
• Alkaline phosphatase: will be disproportionately elevated (≥ 2 times the upper limit of normal) compared to aminotransferases in cholestatic injury
• AST / serum glutamic oxaloacetic transaminase (SGOT): will be elevated ≥ 3 times the upper limit of normal in hepatocellular injury cases, and even > 20 times the upper limit of normal in acute hepatocellular injury
• ALT / serum glutamic pyruvate transaminase (SGPT): will be elevated ≥ 3 times the upper limit of normal in hepatocellular injury cases, and even > 20 times the upper limit of normal in acute hepatocellular injury
• Albumin: will be low in chronic liver injury
• Bilirubin: may be elevated in both hepatocellular and cholestatic injury
• Prothrombin time, will be elevated due to coagulopathy from either hepatocellular or cholestatic injury
• Urinalysis to assess bilirubinuria
• Drug levels, e.g. acetaminophen serum level

The following tests are also helpful in patients presenting with autoimmune-like features:

• Antinuclear antibody
• Anti-mitochondrial antibody (AMA) to distinguish from autoimmune hepatitis
• Anti smooth muscle antibody (ASMA) to distinguish from autoimmune hepatitis