Thématique :
- Hépatites virales
- Foie
Originalité :
Solidité :
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
Journal of Hepatology
  2016 Sep;65(3):532-42  
  doi: 10.1016/j.jhep.2016.05.003  
  Definition and risk factors for chronicity following acute idiosyncratic drug-induced liver injury  
  Medina-Caliz I, Robles-Diaz M, Garcia-Muñoz B, Stephens C, Ortega-Alonso A, Garcia-Cortes M, González-Jimenez A, Sanabria-Cabrera JA, Moreno I, Fernandez MC, Romero-Gomez M, Navarro JM, Barriocanal AM, Montane E, Hallal H, Blanco S, Soriano G, Roman EM, Gómez-Dominguez E, Castiella A, Zapata EM, Jimenez-Perez M, Moreno JM, Aldea-Perona A, Hernández-Guerra M, Prieto M, Zoubek ME, Kaplowitz N, Lucena MI, Andrade RJ; Spanish DILI registry.  


Chronic outcome following acute idiosyncratic drug-induced liver injury (DILI) is not yet defined. This prospective, long-term follow-up study aimed to analyze time to liver enzyme resolutions to establish the best definition and risk factors of DILI chronicity.


298 out of 850 patients in the Spanish DILI registry with no pre-existing disease affecting the liver and follow-up to resolution or ⩾1year were analyzed. Chronicity was defined as abnormal liver biochemistry, imaging test or histology one year after DILI recognition.


Out of 298 patients enrolled 273 (92%) resolved ⩽1year from DILI recognition and 25 patients (8%) were chronic. Independent risk factors for chronicity were older age [OR: 1.06, p=0.011], dyslipidemia [OR: 4.26, p=0.04] and severe DILI [OR: 14.22, p=0.005]. Alanine aminotransferase (ALT), alkaline phosphatase (ALP) and total bilirubin (TB) median values were higher in the chronic group during follow-up. Values of ALP and TB >1.1 x upper limit of normal (xULN) and 2.8 xULN respectively, in the second month from DILI onset, were found to predict chronic DILI (p<0.001). Main drug classes involved in chronicity were statins (24%) and anti-infectives (24%). Histological examination in chronic patients demonstrated two cases with ductal lesion and seven with cirrhosis.


One year is the best cut-off point to define chronic DILI or prolonged recovery, with risk factors being older age, dyslipidemia and severity of the acute episode. Statins are distinctly related to chronicity. ALP and TB values in the second month could help predict chronicity or very prolonged recovery.


Drug-induced liver injury (DILI) patients who do not resolve their liver damage during the first year should be considered chronic DILI patients. Risk factors for DILI chronicity are older age, dyslipidemia and severity of the acute episode. Chronic DILI is not a very common condition; normally featuring mild liver profile abnormalities and not being an important clinical problem, with the exception of a small number of cases of early onset cirrhosis.

Question posée
Mieux définir la notion d’atteinte hépatique chronique médicamenteuse.
Question posée
La proposition des auteurs est d’attendre une année pour retenir le diagnostic.

Un travail qui propose des limites qui seront toujours bien arbitraires.