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

Alisa Likhitsup1, Zemin Su2, Jody A Rule3

  • 1Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|November 21, 2025
PubMed
Summary

A new DILI inpatient score aids in predicting survival for patients with drug-induced liver injury. This score helps identify those with a lower chance of spontaneous recovery, guiding medical decisions.

Keywords:
Acute Liver FailureDiver TransplantationDrug HepatotoxicityPrognostic Index

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Area of Science:

  • Hepatology
  • Clinical Toxicology
  • Internal Medicine

Background:

  • Idiosyncratic drug-induced liver injury (DILI) leading to acute liver failure (ALF) carries a high mortality rate.
  • Identifying factors for nonspontaneous survival in severe DILI is crucial for patient management.

Purpose of the Study:

  • To identify presenting features associated with nonspontaneous survival in hospitalized patients with severe idiosyncratic DILI.
  • To develop and validate a prognostic score for predicting outcomes in DILI patients.

Main Methods:

  • Analysis of 305 adult participants from the Acute Liver Failure Study Group (ALFSG) registry (1998-2019).
  • Development of a multivariable model to predict 21-day outcome (death or liver transplantation).
  • Comparison of the novel DILI inpatient score with the Model for End-Stage Liver Disease (MELD) and King's College Criteria.

Main Results:

  • The study included 44 patients with acute liver injury (ALI) and 261 with ALF due to DILI.
  • Herbal-dietary supplements were implicated in 16% of DILI cases.
  • The DILI inpatient score demonstrated superior predictive accuracy (AUROC 0.86) for 21-day nonspontaneous survival compared to MELD (0.79) and King's College Criteria (0.63).

Conclusions:

  • A novel DILI inpatient prognostic score effectively identifies patients at lowest risk of spontaneous survival.
  • This score can serve as a valuable tool for medical decision-making in hospitalized DILI patients.
  • Further validation in independent cohorts is recommended.