Drug induced liver injury classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rachita Navara, M.D. [2]

Drug induced liver injury may be classified into multiple subtypes based on clinical presentation, mechanism, or histologic findings.^[1]

Drug induced liver injury may be classified into multiple subtypes based on clinical presentation, mechanism, or histologic findings.

• 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)

• 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)

• Both alkaline phosphatase and transaminases are elevated in roughly equal proportion, and/or an alanine aminotransferase to alkaline phosphatase ratio between 2-5

• e.g. Acetaminophen-induced centrilobular necrosis

• 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 may be further subclassified into:

• Hepatitis (hepatocellular injury)
• Cholestasis
• Granulomatous
• Steatosis
• Fibrosis