Drug-Induced Acute and Acute on Chronic Liver Failure

Abstract

Drug induced liver injury (DILI) has varied presentation and a small subset of these patients presents as acute liver failure (ALF) or acute-on-chronic liver failure (ACLF) in clinical setting. In the current era, where medication and dietary supplements are easily available, herbal and dietary supplement (HDS) are leading causes inciting liver injury. DILI is still a diagnosis of exclusion. Absence of defined biomarkers adds to under diagnosis or misdiagnosis of this important disease entity. DILI-ALF or DILI-ACLF usually presents as idiosyncratic DILI (iDILI). iDILI carries a high risk of mortality in the setting of development of liver failure. DILI is a disease manifestation of an interaction of drugs pharmacodynamics and patients genetic behaviour. iDILI is a complex interplay between host, drug and environmental factors. Host factors like older age, female preponderance and co-morbid conditions are associated with development of DILI [1]. Liver injury may be dose dependent, which is more predictable, or it may be idiosyncratic, which is immunologically mediated and is thus unpredictable and more severe. Drugs with higher dose per day and lipophilicity have increased risk of developing DILI [2].