ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury

被引:273
作者
Chalasani, Naga P. [1 ]
Maddur, Haripriya [2 ]
Russo, Mark W. [3 ]
Wong, Robert J. [4 ]
Reddy, K. Rajender [5 ]
机构
[1] Indiana Univ Sch Med, Dept Med, Indianapolis, IN 46202 USA
[2] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA
[3] Atrium Hlth, Carolinas Med Ctr, Charlotte, NC USA
[4] Stanford Univ, Sch Med, Vet Affairs Palo Alto Healthcare Syst, Palo Alto, CA 94304 USA
[5] Univ Penn, Philadelphia, PA 19104 USA
关键词
INTRAVENOUS N-ACETYLCYSTEINE; TRANSPLANT-FREE SURVIVAL; HEPATITIS-C VIRUS; UNITED-STATES; VENOOCCLUSIVE DISEASE; CAUSALITY ASSESSMENT; INTRAHEPATIC CHOLANGIOCARCINOMA; AUTOIMMUNE HEPATITIS; AMERICAN ASSOCIATION; ADVERSE REACTIONS;
D O I
10.14309/ajg.0000000000001259
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Idiosyncratic drug-induced liver injury (DILI) is common in gastroenterology and hepatology practices, and it can have multiple presentations, ranging from asymptomatic elevations in liver biochemistries to hepatocellular or cholestatic jaundice, liver failure, or chronic hepatitis. Antimicrobials, herbal and dietary supplements, and anticancer therapeutics (e.g., tyrosine kinase inhibitors or immune-checkpoint inhibitors) are the most common classes of agents to cause DILI in the Western world. DILI is a diagnosis of exclusion, and thus, careful assessment for other etiologies of liver disease should be undertaken before establishing a diagnosis of DILI. Model for end-stage liver disease score and comorbidity burden are important determinants of mortality in patients presenting with suspected DILI. DILI carries a mortality rate up to 10% when hepatocellular jaundice is present. Patients with DILI who develop progressive jaundice with or without coagulopathy should be referred to a tertiary care center for specialized care, including consideration for potential liver transplantation. The role of systemic corticosteroids is controversial, but they may be administered when a liver injury event cannot be distinguished between autoimmune hepatitis or DILI or when a DILI event presents with prominent autoimmune hepatitis features.
引用
收藏
页码:878 / 898
页数:21
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