Incidence, Presentation, and Outcomes in Patients With Drug-Induced Liver Injury in the General Population of Iceland

“Drug-Induced Liver Injury Clinical Consortia: a global research response for a worldwide health challenge”

“…[3] Unsurprisingly, the incidence obtained in this analysis was lower than that of prospective designs. [5,6] Other retrospective study cohorts used the Kaiser Permanent Northern California database as a surrogate of a wide population sample to determine the incidence of serious DILI leading to acute liver failure and death. [7] An important limitation of this approach is that to define liver events these studies used ICD-9 (international classification of diseases) codes, which have poor accuracy, leading to low specificity and sensitivity for DILI recognition.…”

“…A recent population-based study took advantage of the excellent and centralized medical care system enjoyed by the well-characterized population of Iceland (about 250,000 adults). [6] Over a 2-year period, 96 patients qualified for DILI (56% female), demonstrating an incidence of 19 cases per 100,000 per year. DILI was caused by a single prescription medication in 75% of the cases, dietary supplements in 16% and multiple agents in 9%.…”

“…[11,14] Prospective DILI consortia make careful case adjudication using expert opinion clinical judgment along complementary standard causality assessment by the Roussel Uclaf Assessment Method . [9][10][11] A consistent characteristic of DILI Registries is the inclusion of patients sicker than those identified in epidemiological efforts, [5,6] with around 70% of the patients jaundiced at presentation and half of them requiring hospitalization (Table 1), [9][10][11] so the proportion of non-'true' DILI cases is probably negligible. This selection bias, probably related to the fact that DILI patients are mainly identified in hospital units, nevertheless, strengthens the phenotypic and genotypic data collection.…”

Increasing impact of drug‐induced liver injury

“…1,2 The Iceland study was remarkable for robust data on nationwide prescriptions and reporting of DILI cases. It is also noteworthy that the population incidence increased with age from 8.5 per 100,000 for those less than 25 years old to 40 per 100,000 for those 70 years and older.…”

Idiosyncratic drug‐induced liver injury: A short review

“…The wide range of clinical presentations and causative drugs and the lack of objective diagnostic markers for iDILI make its diagnosis and management particularly difficult. Despite its low incidence of 19 in 100,000 in the general population,2 physicians must always consider the possibility of iDILI in patients with unexplained liver injury. Moreover, the incidence of iDILI is considered to increase with age; therefore, the incidence of iDILI will rise in countries with aging populations.…”