Value of liver biopsy in the diagnosis of drug-induced liver injury
dc.contributor.author | Ahmad, Jawad | |
dc.contributor.author | Barnhart, Huiman X. | |
dc.contributor.author | Bonacini, Maurizio | |
dc.contributor.author | Ghabril, Marwan | |
dc.contributor.author | Hayashi, Paul H. | |
dc.contributor.author | Odin, Joseph A. | |
dc.contributor.author | Rockey, Don C. | |
dc.contributor.author | Rossi, Simona | |
dc.contributor.author | Serrano, Jose | |
dc.contributor.author | Tillmann, Hans L. | |
dc.contributor.author | Kleiner, David E. | |
dc.contributor.author | Drug-Induced Liver Injury Network | |
dc.contributor.department | Medicine, School of Medicine | |
dc.date.accessioned | 2024-01-12T10:46:50Z | |
dc.date.available | 2024-01-12T10:46:50Z | |
dc.date.issued | 2022 | |
dc.description.abstract | Background & aims: The utility of liver biopsy in diagnosing or staging idiosyncratic drug-induced liver injury (DILI) is unclear. The aim of this study was to determine whether liver histology impacted causality assessment in suspected DILI using a novel simulation model. Methods: Fifty patients enrolled in the DILI Network (DILIN) who had liver biopsies performed within 60 days of DILI onset were randomly selected. All had standard DILIN consensus causality scoring using a 5-point scale (1=definite, 2=highly likely, 3=probable, 4=possible, 5=unlikely) based on 6-month post-injury data. Three experienced hepatologists independently performed a causality assessment using redacted case records, with the biopsy and selected post-biopsy laboratory data removed. The 3 hepatologists also reviewed the liver histology with a hepatopathologist and then repeated causality assessment for each case. Results: Of the 50 cases, there were 42 high causality DILI cases (1, 2 or 3) and 8 low causality cases (4 and 5). The hepatologists judged that liver biopsy was indicated in 62% of patients; after histology review, biopsy was judged to have been helpful in 70% of patients. Histology review changed the causality score in 68% of patients, with an increase in DILI likelihood in 48% and a decrease in 20%. Biopsy results changed diagnostic certainty from less certain (3 or 4) to highly certain (1, 2 or 5) in 38% of patients. Conclusions: Liver histologic findings may help clarify the diagnosis of DILI. Histology appears to be particularly helpful in cholestatic or equivocal cases of DILI (possible or probable), shifting assessment toward a greater or lower certainty of a DILI diagnosis. Lay summary: The utility of liver biopsy in diagnosing or staging idiosyncratic drug-induced liver injury (DILI) is unclear. Herein, we show that, in patients with suspected DILI, a liver biopsy can help physicians diagnose DILI or other causes of liver injury with more certainty. | |
dc.eprint.version | Author's manuscript | |
dc.identifier.citation | Ahmad J, Barnhart HX, Bonacini M, et al. Value of liver biopsy in the diagnosis of drug-induced liver injury. J Hepatol. 2022;76(5):1070-1078. doi:10.1016/j.jhep.2021.12.043 | |
dc.identifier.uri | https://hdl.handle.net/1805/37989 | |
dc.language.iso | en_US | |
dc.publisher | Elsevier | |
dc.relation.isversionof | 10.1016/j.jhep.2021.12.043 | |
dc.relation.journal | Journal of Hepatology | |
dc.rights | Publisher Policy | |
dc.source | PMC | |
dc.subject | Histology | |
dc.subject | Accuracy | |
dc.subject | Assessment | |
dc.subject | Causality | |
dc.title | Value of liver biopsy in the diagnosis of drug-induced liver injury | |
dc.type | Article |