ArticleHepatology (Baltimore, Md.)2022
A revised electronic version of RUCAM for the diagnosis of DILI.
Article in Hepatology (Baltimore, Md.), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 70 papers, 2 of them syntheses that pooled it.
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Who cites it
70 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update.Hepatology international · 2024Guideline
- [Chinese guideline for diagnosis and management of drug-induced liver injury (2023 version)].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2023Guideline
- Sildenafil-associated severe cholestatic drug-induced liver injury presenting as persistent jaundice after stone extraction.Clinical journal of gastroenterology · 2026Article
- Vorasidenib-Induced Acute Liver Injury.Digestive diseases and sciences · 2026Article
- Clinical Characteristics and Risk Factors for Severe Immune-Related Liver Injury Following Nivolumab and Ipilimumab Combination Therapy.Antibodies (Basel, Switzerland) · 2026Article
- A descriptive case series of hepatotoxicity associated with CFTR modulators and possible relevance of pharmacogenetic polymorphisms in cystic fibrosis patients.British journal of clinical pharmacology · 2026Article
- A Scoping Review of Case-Level Causality Assessment Tools Developed Between 2008 and 2023; Strengths, Weaknesses and Potential Future Improvements.Drug safety · 2026Article
- Comments on "Prevalence and risk factors associated with rifampicin-induced cholestasis jaundice among tuberculosis patients in high-incidence setting: a retrospective cohort study".Journal of clinical tuberculosis and other mycobacterial diseases · 2026Article
- The contemporary epidemiology, causes, and management of drug-induced liver injury.Hepatology communications · 2026Review
- Common Causes of Drug-Induced Liver Injury in 2025.The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology · 2026Review
- DILIConsult: A Multi-Agent Large Language Model Framework for Evaluating Drug-Induced Liver Injury in ICU Settings.Pharmacotherapy · 2026Article
- Hepatotoxicity Assessment of Anshenbunao Syrup by Multi-Component Quantification In Vivo/In Vitro and Cell Biological Evaluations.Pharmaceuticals (Basel, Switzerland) · 2026Article
- Beyond the Pump: The Evolving Molecular Landscape of Intrahepatic Cholestasis.Diagnostics (Basel, Switzerland) · 2026Review
- Analysis of risk factors for herb-induced liver injury: a retrospective study from China.Frontiers in pharmacology · 2026Article
- A pharmacist-led framework for antibiotic-associated liver injury: from pharmacovigilance signals to bedside surveillance with the updated RUCAM and susceptibility markers.Frontiers in pharmacology · 2026Review
- Article
- Evaluation of Histological Criteria and Immunoserological Testing of Simplified Criteria for the Diagnosis of Autoimmune Hepatitis.The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology · 2025Article
- Navigating liver toxicity in the age of novel oncological agents.JHEP reports : innovation in hepatology · 2025Review
- Dapagliflozin-Associated Hepatotoxicity With a Positive Rechallenge.ACG case reports journal · 2025Article
- IQ DILI Consensus Opinion: Best Practices for Rechallenge Following Suspected Drug-Induced Liver Injury in Clinical Trials.Drug safety · 2025Article
10 more citing papers are in PubMed but not listed here.
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Abstract
BACKGROUND AND
aimsRoussel Uclaf Causality Assessment Method (RUCAM) for DILI has been hindered by subjectivity and poor reliability. We sought to improve the RUCAM using data from the Drug-Induced Liver Injury Network (DILIN) and the Spanish DILI Registry, published literature, and iterative computer modeling. APPROACH AND
resultsRUCAM criteria were updated, clarified, and computerized. We removed criteria 3 (risk factors) for lack of added value and criteria 4 because we felt it more useful to assess each drug separately. Criteria 6 (drug-specific risk) was anchored to LiverTox likelihood scores. Iterative testing in subsets of 50-100 single-agent, nonherbal cases from both registries was done to optimize performance. We used classification tree analysis to establish diagnostic cutoffs for this revised electronic causality assessment method (RECAM) and compared RECAM with RUCAM for correlation with expert opinion diagnostic categories in 194 DILI cases (98 DILIN, 96 Spanish DILI). Area under receiver operator curves for identifying at least probable DILI were the same at 0.89 for RECAM and RUCAM. However, RECAM diagnostic categories have better observed overall agreement with expert opinion (0.62 vs. 0.56 weighted kappa, p = 0.14), and had better sensitivity to detect extreme diagnostic categories (73 vs. 54 for highly likely or high probable, p = 0.02; 65 vs. 48 for unlikely/excluded, p = 0.08) than RUCAM diagnostic categories.
conclusionsRECAM is an evidence-based update that is at least as capable as RUCAM in diagnosing DILI compared with expert opinion but is better than RUCAM at the diagnostic extremes. RECAM's increased objectivity and clarity will improve precision, reliability, and standardization of DILI diagnosis, but further refinement and validation in other cohorts are needed.
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