中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 40 Issue 6
Jun.  2024
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(6): 1203-1208

Value of different assessment scales in the diagnosis of drug-induced liver injury

DOI: 10.12449/JCH240621

  • Department of Infectious Diseases，Peking University First Hospital，Beijing 100034，China

Research funding:

National Natural Science Foundation of China (81870417);

National Natural Science Foundation of China (82070605)

More Information
  • Corresponding author: WANG Yan， wangyanwang@126.com （ORCID： 0000-0002-8577-0527）; WANG Guiqiang， john131212@126.com （ORCID： 0000-0003-0515-7974）
  • Received Date: 2023-08-26
  • Accepted Date: 2023-11-06
  • Published Date: 2024-06-25
    Abstract
  •   Objective  To determine the scores of patients with a confirmed diagnosis of drug-induced liver injury （DILI） using Roussel Uclaf Causality Assessment Method （RUCAM）， Maria & Victorino assessment scale， and Revised Electronic Causality Assessment Method （RECAM）， to compare the accuracy of the three scales in diagnosis， and to investigate their clinical significance in the diagnosis of DILI.  Methods  A total of 98 patients with a confirmed diagnosis of DILI who were hospitalized in Peking University First Hospital from January 2011 to December 2022 were enrolled， with liver biopsy results supporting DILI and a clear history of medication. Clinical data were collected from all subjects， and the above causality assessment scales were used for scoring. The chi-square test was used to analyze the diagnostic accuracy of the causality assessment scales， and the weighted kappa coefficient was used to analyze the consistency between the three scales.  Results  For all patients with DILI enrolled， RECAM had the highest accuracy， with a significant difference compared with RUCAM （χ2=5.667，P=0.017）. RUCAM and RECAM had moderate consistency in diagnosis （κw=0.469）， while RECAM and Maria & Victorino scale had poor consistency （κw=0.156）. For the patients with acute DILI， RECAM， RUCAM， and Maria & Victorino scales had a diagnostic inconsistency rate of 3.7%， 11.1%， and 42.6%， respectively； for the patients with hepatocellular type DILI， the three scales of a diagnostic inconsistency rate of 8.9%， 21.4%， and 62.5%， respectively； for the patients with cholestasis type or mixed type DILI， the three scales of a diagnostic inconsistency rate of 10.0%， 22.5%， and 47.5%， respectively.  Conclusion  The use of RECAM and RUCAM scales in acute DILI can improve diagnostic rate， and for hepatocellular type DILI and DILI with the clinical manifestation of cholestasis （cholestasis type DILI and mixed type DILI）， the use of RECAM and RUCAM scales can also improve diagnostic rate. The selection of causality assessment scales with a relatively high accuracy based on the course and clinical classification of the disease may help to further improve clinical diagnostic rate.

     

    • FullText(HTML)
  • loading
    • References(14)
  • [1]
    HOOFNAGLE JH, BJORNSSON ES. Drug-induced liver injury-types and phenotypes[J]. N Engl J Med, 2019, 381( 3): 264- 273. DOI: 10.1056/NEJMra1816149.
    [2]
    Drug-induced Liver Disease Study Group, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the management of drug-induced liver injury[J]. J Clin Hepatol, 2015, 31( 11): 1752- 1769. DOI: 10.3760/cma.j.issn.1007-3418.2015.11.004.

    中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南[J]. 临床肝胆病杂志, 2015, 31( 11): 1752- 1769. DOI: 10.3760/cma.j.issn.1007-3418.2015.11.004.
    [3]
    ANDRADE RJ, CHALASANI N, BJORNSSON ES, et al. Drug-induced liver injury[J]. Nat Rev Dis Primers, 2019, 5( 1): 58. DOI: 10.1038/s41572-019-0105-0.
    [4]
    YANG RY, ZHAO XY. Significance of liver histopathological examination diagnosis and treatment of drug- induced liver injury[J]. J Clin Hepatol, 2018, 34( 6): 1172- 1175. DOI: 10.3969/j.issn.1001-5256.2018.06.007.

    杨瑞园, 赵新颜. 肝组织病理学检查在药物性肝损伤诊治中的意义[J]. 临床肝胆病杂志, 2018, 34( 6): 1172- 1175. DOI: 10.3969/j.issn.1001-5256.2018.06.007.
    [5]
    DANAN G, TESCHKE R. RUCAM in drug and herb induced liver injury: the update[J]. Int J Mol Sci, 2015, 17( 1): 14- 46. DOI: 10.3390/ijms17010014.
    [6]
    AITHAL GP, RAWLINS MD, DAY CP. Clinical diagnostic scale: a useful tool in the evaluation of suspected hepatotoxic adverse drug reactions[J]. J Hepatol, 2000, 33( 6): 949- 952. DOI: 10.1016/s0168-8278(00)80127-0.
    [7]
    TAJIRI K, SHIMIZU Y. Practical guidelines for diagnosis and early management of drug-induced liver injury[J]. World J Gastroenterol, 2008, 14( 44): 6774- 6785. DOI: 10.3748/wjg.14.6774.
    [8]
    DAS S, BEHERA SK, XAVIER AS, et al. Agreement among different scales for causality assessment in drug-induced liver injury[J]. Clin Drug Investig, 2018, 38( 3): 211- 218. DOI: 10.1007/s40261-017-0601-5.
    [9]
    LUCENA MI, CAMARGO R, ANDRADE RJ, et al. Comparison of two clinical scales for causality assessment in hepatotoxicity[J]. Hepatology, 2001, 33( 1): 123- 130. DOI: 10.1053/jhep.2001.20645.
    [10]
    MARIA VA, VICTORINO RM. Development and validation of a clinical scale for the diagnosis of drug-induced hepatitis[J]. Hepatology, 1997, 26( 3): 664- 669. DOI: 10.1002/hep.510260319.
    [11]
    LAI RT, CHEN CW, YANG WX, et al. Drug-induced liver Injury Causality Assessment Scale: will RECAM replace RUCAM?[J]. Chin Hepatol, 2022, 27( 7): 725- 729. DOI: 10.14000/j.cnki.issn.1008-1704.2022.07.029.

    赖荣陶, 陈成伟, 阳文新, 等. 药物性肝损伤因果关系评估量表: RECAM将取代RUCAM?[J]. 肝脏, 2022, 27( 7): 725- 729. DOI: 10.14000/j.cnki.issn.1008-1704.2022.07.029.
    [12]
    HAYASHI PH, LUCENA MI, FONTANA RJ, et al. A revised electronic version of RUCAM for the diagnosis of DILI[J]. Hepatology, 2022, 76( 1): 18- 31. DOI: 10.1002/hep.32327.
    [13]
    LEWIS JH. Digitizing DILI: who can? RUCAM? RECAM?[J]. Hepatology, 2022, 76( 1): 3- 5. DOI: 10.1002/hep.32312.
    [14]
    YU YC, FAN Y. Advances in Roussel Uclaf Causality Assessment Method for diagnosis of drug-induced liver injury and its comparison with structured expert opinion process[J]. J Clin Hepatol, 2016, 32( 9): 1706- 1713. DOI: 10.3969/j.issn.1001-5256.2016.09.014.

    于乐成, 范晔. RUCAM诊断药物性肝损伤的进展及其与结构化专家观点评估法的比较[J]. 临床肝胆病杂志, 2016, 32( 9): 1706- 1713. DOI: 10.3969/j.issn.1001-5256.2016.09.014.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(11)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (256) PDF downloads(50) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return