HILI and Causality Assessment Tools

Q: In case of suspected herb-induced liver injury (HILI), different causality assessment models may help in differential diagnosis of such products.

A) True

B) False

Answer: B

Different causality assessment models have been developed for the assessment of Drug-Induced Liver Injury (DILI), which include:

• Roussel Uclaf Causality Assessment Method (RUCAM)
• Drug-Induced Liver Injury Network (DILIN) Causality Scoring System 
• Maria and Victorino scale 
• Naranjo scale

Unfortunately, none provides a good assessment of HILI due to product variability and contamination.

HILI due to herbal and dietary supplements (HDS) requires the following elements to be satisfied:

• Exposure must precede the onset of liver injury* 
• Underlying liver disease should be excluded^
• Injury may improve when the HDS is stopped 

* Although the latent period is highly variable

^ In some cases, injury may initially worsen for days or weeks, and in cases of acute liver failure, declining liver biochemical tests may indicate deterioration rather than improvement

#hepatology

References:

Hayashi PH. Causality assessment in drug-induced liver injury. Semin Liver Dis 2009; 29:348.

Chalasani NP, Maddur H, Russo MW, et al. ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury. Am J Gastroenterol 2021; 116:878.

Hayashi PH, Lucena MI, Fontana RJ. RECAM: A New and Improved, Computerized Causality Assessment Tool for DILI Diagnosis. Am J Gastroenterol 2022; 117:1387.