Overview of causality assessment in drug‐induced liver injury

Hayashi, Machiko

doi:10.1002/cld.615

Cited by 14 publications

(13 citation statements)

References 8 publications

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“…In fact, our first diagnostic hypothesis based on the patient's clinical history was hepatotoxicity induced by amoxicillin-clavulanate, with a cholestatic pattern (R value < 2). Moreover, the assessment of causality, according to the RUCAM score, was 8 (compatible with a probable causality), supporting this hypothesis [4]. Nevertheless, the imaging findings (abdominal ultrasound) and the worsening of cytocholestasis laboratory tests were not compatible with drug-induced hepatotoxicity.…”

Section: Discussionmentioning

confidence: 62%

A Rare Cause of Acute Liver Failure: Diffuse Liver Metastization of Merkel Cell Carcinoma

Santos

Pereira

Coelho

et al. 2019

GE Port J Gastroenterol

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The authors describe a case of a 76-year-old male with a medical history of Merkel cell carcinoma (MCC) of the right lower eyelid. He was admitted to the emergency department due to abdominal pain in the right hypochondrium, nauseas, asthenia, and choluria with 3 days of evolution. Biochemical liver workup revealed a cytocholestase pattern as well as a prolonged prothrombin time. After admission, the patient developed hepatic encephalopathy, and a clinical and analytical worsening was observed. Abdominal ultrasound showed a reduction in the caliber of the hepatic veins, in apparent relation to a parenchymal compression. Liver biopsy was performed and showed an extensive infiltration of the hepatic parenchyma by a solid neoplasm, which, upon immunohistochemical study, was compatible with a diffuse metastization of a MCC. We report this clinical case due to its rarity of presentation and to show the important role of liver biopsy in cases of acute hepatitis.

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Section: Discussionmentioning

confidence: 62%

A Rare Cause of Acute Liver Failure: Diffuse Liver Metastization of Merkel Cell Carcinoma

Santos

Pereira

Coelho

et al. 2019

GE Port J Gastroenterol

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“…The Roussel Uclaf Causality Assessment Model (RUCAM) score and resulting causality grading was used to clinically diagnose HILI: 1‐2, unlikely; 3‐5, possible; 6‐8, probable; and > 9, highly probable. ( 8 )…”

Section: Methodsmentioning

confidence: 99%

Tinospora Cordifolia (Giloy)–Induced Liver Injury During the COVID‐19 Pandemic—Multicenter Nationwide Study From India

Kulkarni

Hanchanale²,

Prakash³

et al. 2022

Hepatol Commun

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Tinospora cordifolia (Giloy) is an herbal supplement commonly used in the Indian alternative medicine system Ayurveda. This herb has been promoted to the public in India as an immune booster to prevent novel coronavirus disease 2019. However, small reports have recently shown an association between Giloy use and the development of herb‐induced liver injury (HILI) with autoimmune features in some patients. This large retrospective Indian multicenter study spanning 13 centers at nine locations was designed to identify features and outcomes of HILI temporally associated with Giloy use. Chemical and toxicological analyses of retrieved Giloy samples using state‐of‐the‐art methods were also performed. We report 43 patients, of whom more than half were female, with a median time from initial Giloy consumption to symptom onset of 46 days. Patients presented with acute hepatitis, acute worsening of chronic liver disease (CLD, the most common clinical presentation), or acute liver failure. Causality assessment revealed probable liver injury in 67.4%. The most common autoantibody detected was anti‐nuclear antibody. Liver biopsy in a subset revealed HILI associated with autoimmune features and hepatocyte and canalicular cholestasis and neutrophilic and eosinophilic infiltration. Conclusion: Giloy is associated with acute hepatitis with autoimmune features and can unmask autoimmune hepatitis (AIH) in people with silent AIH‐related CLD. Further studies on the safety (and efficacy) of untested but heavily promoted herbals in alternative systems of medicine are an unmet need in the interests of public health and are especially important during this global health emergency.

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“…Further, RUCAM can be easily used in clinical fields; however, in the case of liver transplantation for hepatic failure and HDS hepatotoxicity caused by Chinese medicine, health food, and folk remedies, the RUCAM scores may be low. In addition, the reproducibility of scoring is low [19].…”

Section: Roussel Uclaf Causality Assessment Methodsmentioning

confidence: 99%

Drug-induced liver injury

Suh

2020

Yeungnam Univ J Med

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Drug-induced liver injury (DILI), including herbal and dietary supplement hepatotoxicity, is often passed lightly; however, it can lead to the requirement of a liver transplant or may even cause death because of liver failure. Recently, the American College of Gastroenterology, Chinese Society of Hepatology and European Association for the Study of the Liver guidelines for the diagnosis and treatment of DILI have been established, and they will be helpful for guiding clinical treatment decisions. Roussel Uclaf Causality Assessment Method scoring is the most commonly used method to diagnose DILI; however, it has some limitations, such as poor validity and reproducibility. Recently, studies on new biomarkers have been actively carried out, which will help diagnose DILI and predict the prognosis of DILI. It is expected that the development of new therapies such as autophagy inducers and various other technologies of the fourth industrial revolution will be applicable to DILI research.

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Overview of causality assessment in drug‐induced liver injury

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/9-2-reading-hayashi.html a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/9-2-interview-hayashi.html the interview with the author

Cited by 14 publications

References 8 publications

A Rare Cause of Acute Liver Failure: Diffuse Liver Metastization of Merkel Cell Carcinoma

A Rare Cause of Acute Liver Failure: Diffuse Liver Metastization of Merkel Cell Carcinoma

Tinospora Cordifolia (Giloy)–Induced Liver Injury During the COVID‐19 Pandemic—Multicenter Nationwide Study From India

Drug-induced liver injury

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