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. General patterns are summarized below.[1]
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 Once the diagnosis of drug induced liver injury is established and the inciting drug is withdrawn, the "dechallenge" or clinical improvement is relatively immediate.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
Up to 10% of patients with drug induced liver injury may require liver transplantation or do not survive the initial injury. Another 5-10% could be at risk for chronic liver injury, particularly if they have preexisting liver disease. 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.