Drug-induced liver injury. Part I: Classification, diagnosis and treatment

Dorota M. Kozielewicz; Piotr Stalke; Julita Skrzypek

doi:10.5114/ceh.2025.148329

eISSN: 2449-8238
ISSN: 2392-1099

Clinical and Experimental Hepatology

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abstract:

Review paper

Drug-induced liver injury. Part I: Classification, diagnosis and treatment

Dorota M. Kozielewicz

^{1, 2}

,

Piotr Stalke

³

,

Julita Skrzypek

²

Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
Department of Liver Diseases, Provincial Infectious Disease Hospital of T. Browicz, Bydgoszcz, Poland
Department of Infectious Disease, Medical University of Gdansk, Poland

Clin Exp HEPATOL 2025; 11, 1: 25-33

DOI: https://doi.org/10.5114/ceh.2025.148329

Online publish date: 2025/03/25

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Drug-induced liver injury (DILI) is a growing clinical problem. Antibiotics remain the most common cause of DILI in Europe. Their clinical spectrum is very broad, from asymptomatic to acute liver failure. Currently, DILI is categorized as hepatocellular (R ≥ 5), cholestatic (R ≤ 2) or mixed (R = 2-5) injury based on the serum alanine aminotransferase (ALT)/alkaline phosphatase (ALP) ratio. DILI is a diagnosis of exclusion and requires a wide differential diagnosis. The most important step in management is discontinuation of the drug suspected of causing liver damage. The list of specific antidotes that eliminate the effects of hepatotoxins is unfortunately very short. In symptomatic treatment, glucocorticosteroids and ursodeoxycholic acid have been used in selected cases. Liver transplantation is an optional treatment in patients with acute liver failure.

keywords:

Drug-induced liver injury. Part I: Classification, diagnosis and treatment

Dorota M. Kozielewicz 1, 2 , Piotr Stalke 3 , Julita Skrzypek 2

drug-induced liver injury, idiosyncratic DILI, liver toxicity, polypharmacy, adverse reactions

Dorota M. Kozielewicz

^{1, 2}

,

Piotr Stalke

³

,

Julita Skrzypek

²