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Assessment of drug-induced liver injury in clinical practice.
Fundam Clin Pharmacol 2008; 22(2):141-58FC

Abstract

Currently, pharmaceutical preparations are serious contributors to liver disease, with hepatotoxicity ranking as the most frequent cause for acute liver failure and post-marketing regulatory decisions. The diagnostic approach of drug-induced liver injury (DILI) is still rudimentary and inaccurate because of the lack of reliable markers for use in general clinical practice. To incriminate any given drug in an episode of liver dysfunction is a step-by-step process that requires a high degree of suspicion, compatible chronology, awareness of the drug's hepatotoxic potential, the exclusion of alternative causes of liver damage, and the ability to detect the presence of subtle data that favour a toxic aetiology. Clinical and laboratory data may also be assessed with algorithms or clinical scales, which may add consistency to the clinical judgment by translating the suspicion into a quantitative score. The CIOMS/RUCAM instrument is considered at present the best method for assessing causality in DILI, although it could be improved through the use of large database of bona fide DILI cases for validation criteria.

Authors+Show Affiliations

Servicio de Farmacología Clínica, Hospital Universitario Virgen de Victoria, School of Medicine, Málaga, Spain. lucena@uma.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

18353109

Citation

Lucena, Ma Isabel, et al. "Assessment of Drug-induced Liver Injury in Clinical Practice." Fundamental & Clinical Pharmacology, vol. 22, no. 2, 2008, pp. 141-58.
Lucena MI, García-Cortés M, Cueto R, et al. Assessment of drug-induced liver injury in clinical practice. Fundam Clin Pharmacol. 2008;22(2):141-58.
Lucena, M. I., García-Cortés, M., Cueto, R., Lopez-Duran, J., & Andrade, R. J. (2008). Assessment of drug-induced liver injury in clinical practice. Fundamental & Clinical Pharmacology, 22(2), pp. 141-58. doi:10.1111/j.1472-8206.2008.00566.x.
Lucena MI, et al. Assessment of Drug-induced Liver Injury in Clinical Practice. Fundam Clin Pharmacol. 2008;22(2):141-58. PubMed PMID: 18353109.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of drug-induced liver injury in clinical practice. AU - Lucena,Ma Isabel, AU - García-Cortés,Miren, AU - Cueto,Raquel, AU - Lopez-Duran,Jl, AU - Andrade,Raúl J, PY - 2008/3/21/pubmed PY - 2008/6/13/medline PY - 2008/3/21/entrez SP - 141 EP - 58 JF - Fundamental & clinical pharmacology JO - Fundam Clin Pharmacol VL - 22 IS - 2 N2 - Currently, pharmaceutical preparations are serious contributors to liver disease, with hepatotoxicity ranking as the most frequent cause for acute liver failure and post-marketing regulatory decisions. The diagnostic approach of drug-induced liver injury (DILI) is still rudimentary and inaccurate because of the lack of reliable markers for use in general clinical practice. To incriminate any given drug in an episode of liver dysfunction is a step-by-step process that requires a high degree of suspicion, compatible chronology, awareness of the drug's hepatotoxic potential, the exclusion of alternative causes of liver damage, and the ability to detect the presence of subtle data that favour a toxic aetiology. Clinical and laboratory data may also be assessed with algorithms or clinical scales, which may add consistency to the clinical judgment by translating the suspicion into a quantitative score. The CIOMS/RUCAM instrument is considered at present the best method for assessing causality in DILI, although it could be improved through the use of large database of bona fide DILI cases for validation criteria. SN - 1472-8206 UR - https://www.unboundmedicine.com/medline/citation/18353109/Assessment_of_drug_induced_liver_injury_in_clinical_practice_ L2 - https://doi.org/10.1111/j.1472-8206.2008.00566.x DB - PRIME DP - Unbound Medicine ER -