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Value of liver biopsy in the diagnosis of drug-induced liver injury.

Publication ,  Journal Article
Ahmad, J; Barnhart, HX; Bonacini, M; Ghabril, M; Hayashi, PH; Odin, JA; Rockey, DC; Rossi, S; Serrano, J; Tillmann, HL; Kleiner, DE ...
Published in: J Hepatol
May 2022

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.

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Published In

J Hepatol

DOI

EISSN

1600-0641

Publication Date

May 2022

Volume

76

Issue

5

Start / End Page

1070 / 1078

Location

Netherlands

Related Subject Headings

  • Risk Factors
  • Humans
  • Gastroenterology & Hepatology
  • Dyphylline
  • Chemical and Drug Induced Liver Injury
  • Biopsy
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
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Ahmad, J., Barnhart, H. X., Bonacini, M., Ghabril, M., Hayashi, P. H., Odin, J. A., … Drug-Induced Liver Injury Network, . (2022). Value of liver biopsy in the diagnosis of drug-induced liver injury. J Hepatol, 76(5), 1070–1078. https://doi.org/10.1016/j.jhep.2021.12.043
Ahmad, Jawad, Huiman X. Barnhart, Maurizio Bonacini, Marwan Ghabril, Paul H. Hayashi, Joseph A. Odin, Don C. Rockey, et al. “Value of liver biopsy in the diagnosis of drug-induced liver injury.J Hepatol 76, no. 5 (May 2022): 1070–78. https://doi.org/10.1016/j.jhep.2021.12.043.
Ahmad J, Barnhart HX, Bonacini M, Ghabril M, Hayashi PH, Odin JA, et al. Value of liver biopsy in the diagnosis of drug-induced liver injury. J Hepatol. 2022 May;76(5):1070–8.
Ahmad, Jawad, et al. “Value of liver biopsy in the diagnosis of drug-induced liver injury.J Hepatol, vol. 76, no. 5, May 2022, pp. 1070–78. Pubmed, doi:10.1016/j.jhep.2021.12.043.
Ahmad J, Barnhart HX, Bonacini M, Ghabril M, Hayashi PH, Odin JA, Rockey DC, Rossi S, Serrano J, Tillmann HL, Kleiner DE, Drug-Induced Liver Injury Network. Value of liver biopsy in the diagnosis of drug-induced liver injury. J Hepatol. 2022 May;76(5):1070–1078.
Journal cover image

Published In

J Hepatol

DOI

EISSN

1600-0641

Publication Date

May 2022

Volume

76

Issue

5

Start / End Page

1070 / 1078

Location

Netherlands

Related Subject Headings

  • Risk Factors
  • Humans
  • Gastroenterology & Hepatology
  • Dyphylline
  • Chemical and Drug Induced Liver Injury
  • Biopsy
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences