Editorial

. 2017 May;11(3):221-241.

doi: 10.1007/s12072-017-9793-2. Epub 2017 Apr 12.

CSH guidelines for the diagnosis and treatment of drug-induced liver injury

Yue-Cheng Yu¹, Yi-Min Mao², Cheng-Wei Chen³, Jin-Jun Chen⁴, Jun Chen⁵, Wen-Ming Cong⁶, Yang Ding⁷, Zhong-Ping Duan⁸, Qing-Chun Fu⁹, Xiao-Yan Guo¹⁰, Peng Hu¹¹, Xi-Qi Hu¹², Ji-Dong Jia¹³, Rong-Tao Lai¹⁴, Dong-Liang Li¹⁵, Ying-Xia Liu¹⁶, Lun-Gen Lu¹⁷, Shi-Wu Ma¹⁸, Xiong Ma¹⁹, Yue-Min Nan²⁰, Hong Ren¹¹, Tao Shen²¹, Hao Wang²², Ji-Yao Wang²³, Tai-Ling Wang²⁴, Xiao-Jin Wang⁹, Lai Wei²², Qing Xie¹⁴, Wen Xie²⁵, Chang-Qing Yang²⁶, Dong-Liang Yang²⁷, Yan-Yan Yu²⁸, Min-de Zeng¹⁹, Li Zhang²⁹, Xin-Yan Zhao¹³, Hui Zhuang²¹; Drug-induced Liver Injury (DILI) Study Group; Chinese Society of Hepatology (CSH); Chinese Medical Association (CMA)

Affiliations

¹ Liver Disease Center of PLA, Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing, 210002, China.
² Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China. maoym11968@163.com.
³ Shanghai Liver Diseases Research Center, 85th Hospital, Nanjing Military Command, Shanghai, 200235, China. ccw2@163.com.
⁴ Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
⁵ Liver Diseases Center, Second Xiangya Hospital, Central South University, Changsha, 410011, China.
⁶ Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 201805, China.
⁷ Department of Infectious Disease, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
⁸ Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
⁹ Shanghai Liver Diseases Research Center, 85th Hospital, Nanjing Military Command, Shanghai, 200235, China.
¹⁰ Department of Gastroenterology, Second Affiliated Hospital, Xi'an Jiaotong University, Xian, 710004, China.
¹¹ Department of Infectious Diseases, Institute for Viral Hepatitis, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China.
¹² Department of Pathology, School of Medicine, Fudan University, Shanghai, 200433, China.
¹³ Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, 100069, China.
¹⁴ Department of Infectious Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
¹⁵ Department of Hepatobiliary Disease, Fuzhou General Hospital of PLA, Fuzhou, 350025, China.
¹⁶ Department of Liver Disease, Shenzhen Third People's Hospital, Shenzhen, 518040, China.
¹⁷ Department of Gastroenterology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200080, China.
¹⁸ Department of Infectious Diseases, Kunming General Hospital of PLA, Kunming, 650032, China.
¹⁹ Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China.
²⁰ Department of Traditional and Western Medical Hepatology, Third Affiliated Hospital, Hebei Medical University, Shijiazhuang, 050051, China.
²¹ Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Beijing University, Beijing, 100083, China.
²² Institute of Hepatology, People's Hospital, Beijing University, Beijing, 100044, China.
²³ Department of Gastroenterology, Zhongshan Hospital, School of Medicine, Fudan University, Shanghai, 200032, China.
²⁴ Department of Pathology, China-Japan Friendship Hospital, Capital Medical University, Beijing, 100029, China.
²⁵ Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100011, China.
²⁶ Department of Gastroenterology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065c, China.
²⁷ Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
²⁸ Department of Infectious Disease, Beijing University First Hospital, Beijing, 100034, China.
²⁹ Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078c, China.

PMID: 28405790
PMCID: PMC5419998
DOI: 10.1007/s12072-017-9793-2

Editorial

CSH guidelines for the diagnosis and treatment of drug-induced liver injury

Yue-Cheng Yu et al. Hepatol Int. 2017 May.

. 2017 May;11(3):221-241.

doi: 10.1007/s12072-017-9793-2. Epub 2017 Apr 12.

Authors

Affiliations

¹ Liver Disease Center of PLA, Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing, 210002, China.
² Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China. maoym11968@163.com.
³ Shanghai Liver Diseases Research Center, 85th Hospital, Nanjing Military Command, Shanghai, 200235, China. ccw2@163.com.
⁴ Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
⁵ Liver Diseases Center, Second Xiangya Hospital, Central South University, Changsha, 410011, China.
⁶ Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 201805, China.
⁷ Department of Infectious Disease, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
⁸ Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
⁹ Shanghai Liver Diseases Research Center, 85th Hospital, Nanjing Military Command, Shanghai, 200235, China.
¹⁰ Department of Gastroenterology, Second Affiliated Hospital, Xi'an Jiaotong University, Xian, 710004, China.
¹¹ Department of Infectious Diseases, Institute for Viral Hepatitis, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China.
¹² Department of Pathology, School of Medicine, Fudan University, Shanghai, 200433, China.
¹³ Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, 100069, China.
¹⁴ Department of Infectious Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
¹⁵ Department of Hepatobiliary Disease, Fuzhou General Hospital of PLA, Fuzhou, 350025, China.
¹⁶ Department of Liver Disease, Shenzhen Third People's Hospital, Shenzhen, 518040, China.
¹⁷ Department of Gastroenterology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200080, China.
¹⁸ Department of Infectious Diseases, Kunming General Hospital of PLA, Kunming, 650032, China.
¹⁹ Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China.
²⁰ Department of Traditional and Western Medical Hepatology, Third Affiliated Hospital, Hebei Medical University, Shijiazhuang, 050051, China.
²¹ Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Beijing University, Beijing, 100083, China.
²² Institute of Hepatology, People's Hospital, Beijing University, Beijing, 100044, China.
²³ Department of Gastroenterology, Zhongshan Hospital, School of Medicine, Fudan University, Shanghai, 200032, China.
²⁴ Department of Pathology, China-Japan Friendship Hospital, Capital Medical University, Beijing, 100029, China.
²⁵ Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100011, China.
²⁶ Department of Gastroenterology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065c, China.
²⁷ Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
²⁸ Department of Infectious Disease, Beijing University First Hospital, Beijing, 100034, China.
²⁹ Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078c, China.

PMID: 28405790
PMCID: PMC5419998
DOI: 10.1007/s12072-017-9793-2

Abstract

Drug-induced liver injury (DILI) is an important clinical problem, which has received more attention in recent decades. It can be induced by small chemical molecules, biological agents, traditional Chinese medicines (TCM), natural medicines (NM), health products (HP), and dietary supplements (DS). Idiosyncratic DILI is far more common than intrinsic DILI clinically and can be classified into hepatocellular injury, cholestatic injury, hepatocellular-cholestatic mixed injury, and vascular injury based on the types of injured target cells. The CSH guidelines summarized the epidemiology, pathogenesis, pathology, and clinical manifestation and gives 16 evidence-based recommendations on diagnosis, differential diagnosis, treatment, and prevention of DILI.

Keywords: Clinical type; Diagnosis; Differential diagnosis; Drug-induced liver injury; Epidemiology; Pathogenesis; Pathology; Prevention; Recommendations; Treatment.

PubMed Disclaimer

Conflict of interest statement

Funding

This guideline is supported by the National Major Projects during the Twelfth Five-year Plan Period, Project (No. 2012ZX09303-001).

Conflict of interest

Yue-cheng Yu, Yi-min Mao, Cheng-wei Chen, Jin-jun Chen, Jun Chen, Wen-ming Cong, Yang Ding, Zhong-ping Duan, Qing-chun Fu, Xiao-yan Guo, Peng Hu, Xi-qi Hu, Ji-dong Jia, Rong-tao Lai, Dong-liang Li, Ying-xia Liu, Lun-gen Lu, Shi-wu Ma, Xiong Ma, Yue-min Nan, Hong Ren, Tao Shen, Hao Wang, Ji-yao Wang, Tai-ling Wang, Xiao-jin Wang, Lai Wei, Qing Xie, Wen Xie, Chang-qing Yang, Dong-liang Yang, Yan-yan Yu, Min-de Zeng, Li Zhang, Xin-yan Zhao, Hui Zhuang declare no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

**Fig. 1**
Algorithm for the diagnosis of DILI. *BCS* Budd–Chiari syndrome, *IPH* idiopathic portal hypertension, *NRH* nodular regenerative hyperplasia, PH peliosis hepatis, *SOS/VOD* sinusoidal obstruction syndrome/veno-occlusive disease. *Asterisk R* = (actual ALT/ULN)/(actual ALP/ULN). Triangle see Table 3

See this image and copyright information in PMC

References

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1. Chalasani NP, Hayashi PH, Bonkovsky HL, et al. ACG Clinical Guide: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2014;109(7):950–966. doi: 10.1038/ajg.2014.131. - DOI - PubMed
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CSH guidelines for the diagnosis and treatment of drug-induced liver injury

Affiliations

CSH guidelines for the diagnosis and treatment of drug-induced liver injury

Authors

Affiliations

Abstract

Conflict of interest statement

Funding

Conflict of interest

Ethical approval

Figures

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Molecular Biology Databases

Research Materials

Miscellaneous