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Assessment of drug‐induced liver injury in clinical practice
Author(s) -
Isabel Lucena Ma,
GarcíaCortés Miren,
Cueto Raquel,
LopezDuran JL,
Andrade Raúl J
Publication year - 2008
Publication title -
fundamental and clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.655
H-Index - 73
eISSN - 1472-8206
pISSN - 0767-3981
DOI - 10.1111/j.1472-8206.2008.00566.x
Subject(s) - drug , liver injury , medicine , causality (physics) , intensive care medicine , clinical practice , consistency (knowledge bases) , etiology , liver damage , ranking (information retrieval) , drug development , pharmacology , family medicine , computer science , physics , quantum mechanics , artificial intelligence , machine learning
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.