The clinical implications of the biopsy findings in cases of drug-induced liver injury (DILI) are not fully elucidated. The aim of this study was to evaluate the histopathological findings of cases diagnosed as DILI and to correlate them with clinical and biochemical findings (such as causality assessment algorithms). We searched our department database for all cases of liver biopsy with findings consistent with toxic liver disease and selected those with a clinical diagnosis of DILI. The causative relationships were established according to Roussel Uclaf Causality Assessment Method (RUCAM). A total of 53 cases of DILI were reviewed, most of them diagnosed in hospitalized patients (83%). The analytical toxicity profile was hepatocellular (R > 5) in 60% of the cases and cholestatic (R < 2) in 26.4% of cases. The group of drugs most implicated was the anti-microbials (18, 34%). The predominant histological patterns were "necroinflammation" (67.9%) and "cholestasis" (28.3%). The hepatocellular biochemical pattern was not associated with the presence of predominantly necroinflammatory findings in the biopsy (p = 0.44), and the biochemical cholestatic pattern was not associated with the presence of predominantly cholestatic findings in the biopsy (p = 0.51). This study supports that a better insight into the pathologic mechanisms associated with DILI should be based on liver biopsy due to the lack of a uniform correlation between clinical and biochemical patterns. Also, a liver biopsy may be used in those cases where clinical suspicion of DILI persists despite a low score on current causality assessment algorithms.

中文翻译：

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肝活检在“药物诱发的肝损伤”（DILI）临床预测分数时代的作用：三级转诊医院的经验。

尚未完全阐明在药物性肝损伤（DILI）病例中活检结果的临床意义。这项研究的目的是评估诊断为DILI的病例的组织病理学发现，并将其与临床和生化发现（例如因果关系评估算法）相关联。我们在部门数据库中搜索了所有与活毒性肝病相符的肝活检病例，并选择了具有DILI临床诊断的病例。根据Roussel Uclaf因果关系评估方法（RUCAM）建立了因果关系。回顾了总共53例DILI病例，其中大多数在住院患者中被诊断出（83％）。分析毒性谱图为60％的病例为肝细胞（R> 5），26.4％的病例为胆汁淤积（R <2）。牵连最多的药物是抗微生物剂（18，34％）。主要的组织学类型是“坏死性炎症”（67.9％）和“胆汁淤积”（28.3％）。肝细胞生化模式与活检中主要为坏死性炎症的发现无关（p = 0.44），生化胆汁镇静模式与活检中主要为胆汁淤积的发现无关（p = 0.51）。这项研究支持，由于临床和生化模式之间缺乏统一的相关性，因此应基于肝活检对与DILI相关的病理机制有更好的了解。另外，尽管当前因果关系评估算法评分较低，但仍持续存在对DILI的临床怀疑的情况下，可以使用肝活检。