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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Drug induced liver injury classification

Introduction

Overview

Overview

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

Classification

Classification

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

Clinical presentation:

Hepatocellular injury

  • 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)

Cholestatic injury

  • 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)

Mixed injury

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

Mechanism:

Dose-dependent hepatotoxicity

  • e.g. Acetaminophen-induced centrilobular necrosis

Idiosyncratic hepatotoxicity

  • 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:

Histologic findings may be further subclassified into:

References

References

  1. ↑ Fisher K, Vuppalanchi R, Saxena R (2015). “Drug-Induced Liver Injury”. Arch Pathol Lab Med. 139 (7): 876–87. doi:10.5858/arpa.2014-0214-RA. PMID 26125428.

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