Related Experiment Video
Updated: Sep 9, 2025
Inducing Acute Liver Injury in Rats via Carbon Tetrachloride CCl4 Exposure Through an Orogastric Tube
Published on: April 28, 2020
DILI Is an Important Cause of Hepatocellular and Mixed Liver Injury-A Nationwide Prospective Study on Elevated Liver
S S Sigurdarson1, H K Bjornsson2, B L Snorrason1
1Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
Background And Aims:
Very few prospective studies have investigated the most common causes of concomitant elevation of ALT and ALP. We aimed to investigate the most common aetiologies of hepatocellular or cholestatic liver injury, and to study the proportion of patients with DILI.
Methods:
A 2-year prospective study, in Landspitali Hospital, Iceland on patients with (A) ALT > 500 and (B) ALT > 250 U/L and ALP > 210 U/L. Appropriate diagnostic work-up was undertaken. Causality assessment in suspected DILI was with RECAM and expert opinion.
Results:
A total of 835 patients were identified with: ALT > 500 U/L (n = 500) or ALT > 250 and ALP > 210 (n = 318), 17 were excluded due to a lack of information or elevations of non-liver related causes. Among 818 patients: 451 females (55%), median age 58 (IQR 40-72). The most common causes were choledocholithiasis 42%, ischaemic hepatitis (IH) 17%, hepato-biliary cancer (HBC) 8.4%, DILI 8.2%, viral hepatitis 6.2%, other aetiologies 11% and unknown aetiologies in 7.8%. IH was significantly more common in Group A but HBC in Group B. DILI was similar in both groups. Amoxicillin-clavulanate, checkpoint inhibitors, herbal-dietary supplements (HDS) and paracetamol were the major causative agents in DILI patients. IH and HBC patients had the highest mortality. Two DILI patients died of liver failure and one patient needed emergency liver transplantation associated with HDS.
Conclusions:
The most common cause in both groups was choledocholithiasis. IH was associated with hepatocellular injury whereas HBC was associated with cholestatic injury. DILI was an important aetiology with 8% prevalence in the cohort and was similar in the two groups.
Related Concept Videos
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
01:24Liver Regeneration
Cells of Liver
The liver comprises four major types of cells— hepatocytes, stellate, Kupffer, and sinusoidal endothelial cells. The hepatocytes are...
01:30Liver Physiology
Metabolic Regulation:
The liver is the central organ involved in regulating blood composition. It stabilizes blood glucose levels, maintaining them within the range of 70–110 mg/dL. When these levels drop, the liver breaks down glycogen reserves and releases glucose into the bloodstream. It can...
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...