Diagnosis and treatment of drug-induced liver injury

Due to a lack of specific biomarkers, the diagnosis of drug-induced liver injury (DILI) mainly depends on the method of exclusion. The Roussel Uclaf Causality Assessment Method (RUCAM) scale is the most widely used causality assessment scale and is relatively objective, but it is still waiting for further improvement. Another method is global introspection or expert opinion, which is relatively subjective, and the simplified global introspection method is commonly used in clinical practice. The Structured Expert Opinion Procedure (SEOP) created by the US DILI network (DILIN) is very complicated and time-consuming and thus cannot be used in clinical practice. The drug rechallenge test (DRT) with a positive result is considered the gold standard for the diagnosis of DILI, but DILI cannot be excluded based on the negative result of DRT. The value of lymphocyte transformation test (LTT) , modified LTT, monocyte-derived hepatocyte-like cell lactate-dehydrogenase release test, and various predictive models for drug hepatotoxicity in the diagnosis of DILI awaits further assessment.The differential diagnosis of autoimmune-mediated DILI and traditional autoimmune liver diseases usually depends on liver biopsy, the type and titer of autoantibody, and response to glucocorticoids. Reasonable timing of drug withdrawal and application of anti-inflammatory liver-protecting drugs may help most DILI patients recover. Generally, the prophylactic use of anti-inflammatory liver-protecting drugs is not recommended, except in special situations. In-depth studies are needed for the precise diagnosis and prevention/treatment of DILI.