The DILI-Inpt Prognostic Score to Identify Hospitalized Idiosyncratic DILI Patients at Risk for Adverse Outcomes

Acute liver failure (ALF) due to idiosyncratic drug-induced liver injury (DILI) has a poor prognosis. We set out to identify presenting features associated with nonspontaneous survival in hospitalized patients with severe idiosyncratic DILI.

A total of 305 adult ALFSG (Acute Liver Failure Study Group) registry participants from January 1998 to August 2019 had acute liver injury (ALI) (ie, international normalized ratio >2.0 without encephalopathy) or ALF attributed to DILI. A multivariable model was developed to predict 21-day outcome (death or liver transplantation) using admission data and was compared with the Model for End-Stage Liver Disease (MELD) and King's College Criteria scores.

A total of 44 DILI patients had ALI and 261 had ALF. The median age was 44 years, 67% were female, and the median MELD score was 32 (range 14-54). Suspect agents included antimicrobials (42.6%), herbal-dietary supplements (16%), and psychoactive drugs (9.8%). At 21 days, 110 (36%) were spontaneous survivors and 195 (64%) were nonspontaneous survivors, including 115 that required liver transplantation and 80 who died. The DILI inpatient score (consisting of total bilirubin, INR, encephalopathy grade, and herbal and dietary supplement products) had an area under the receiver-operating characteristic curve (AUROC) of 0.86 (95% confidene interval, 0.82-0.91) for 21-day nonspontaneous survival that was superior to the MELD (AUROC 0.86 vs 0.79; P = .008) and King's College Criteria (AUROC 0.86 vs 0.63; P < .001) scores.

The new DILI inpatient prognostic score identified patients with the lowest likelihood of spontaneous survival. This simple prognostic score may be a useful guide for medical decision making in hospitalized DILI patients if confirmed in other cohorts.

gov, Number: NCT00518440.