Evidence map›Paper›PMID 35081550›Full record

ArticleThe American journal of gastroenterology2022

Secular Trends in Severe Idiosyncratic Drug-Induced Liver Injury in North America: An Update From the Acute Liver Failure Study Group Registry.

Ashwin Rao, Jody A Rule, Bilal Hameed, Daniel Ganger, Robert J Fontana, William M Lee

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The American journal of gastroenterology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 3 pooled it
4.4field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 3 syntheses or guidelines pooled it, 26 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. [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 · 2023
    Guideline
  4. Serum Hepatocyte Growth Factor Predicts Outcomes in Non-Acetaminophen Drug-Induced Acute Liver Failure.Liver international : official journal of the International Association for the Study of the Liver · 2026
    Article
  5. Review
  6. The DILI-Inpt Prognostic Score to Identify Hospitalized Idiosyncratic DILI Patients at Risk for Adverse Outcomes.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026
    Observational
  7. Article
  8. Article
  9. Article
  10. Article
  11. Natural History of Idiosyncratic Drug-Induced Liver Injury and Prognostic Models.Liver international : official journal of the International Association for the Study of the Liver · 2025
    Review
  12. Review
  13. Review
  14. Review
  15. [Progress on the research of liver diseases in 2022].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2023
    Article
  16. Management of Acute Liver Failure: Update 2022.Seminars in liver disease · 2022
    Article
  17. [Progress on liver diseases in 2021].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2022
    Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 1 country.

Ashwin RaoDepartment of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Jody A RuleDepartment of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Bilal HameedDivision of Gastroenterology and Hepatology, University of California San Francisco School of Medicine, San Francisco, California, USA.
Daniel GangerDivision of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois, USA.
Robert J FontanaDivision of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
William M LeeDepartment of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
The University of Texas Southwestern Medical Center · USNorthwestern Medicine · USUniversity of California, San Francisco · USUniversity of Michigan–Ann Arbor · US

Funding

A Multi-Center Study of Acute Liver Failure in AdultsU01DK058369 · NIDDK · UT SOUTHWESTERN MEDICAL CENTER · PI DURKALSKI, VALERIE L, FONTANA, ROBERT J · 2005 to 2019
$27.4M
A MULTI-CENTER THERAPY TRIAL FOR ACUTE LIVER FAILURER01DK058369 · NIDDK · UNIVERSITY OF TEXAS SW MED CTR/DALLAS · PI LEE, WILLIAM M · 2000 to 2004
$4.2M
NIDDK NIH HHS R01 DK058369NIDDK NIH HHS U01 DK058369
6 · The paper itself

Abstract

introductionIdiosyncratic drug-induced liver injury (DILI) is the second leading cause of acute liver failure (ALF) in the United States. Our study aims were to characterize secular trends in the implicated agents, clinical features, and outcomes of adults with DILI ALF over a 20-year period.

methodsAmong 2,332 patients with ALF enrolled in the ALF Study Group registry, 277 (11.9%) were adjudicated as idiosyncratic DILI ALF (INR ≥ 1.5 and hepatic encephalopathy) through expert opinion. The 155 cases in era 1 (January 20, 1998-January 20, 2008) were compared with the 122 cases in era 2 (January 21, 2008-January 20, 2018).

resultsAmong 277 cases of DILI ALF, 97 different agents, alone or in combination, were implicated: antimicrobials, n = 118 (43%); herbal/dietary supplements (HDS), n = 42 (15%); central nervous system agents/illicit substances, n = 37 (13%); oncologic/biologic agents, n = 29 (10%); and other, n = 51 (18%). Significant trends over time included (i) an increase in HDS DILI ALF (9.7% vs 22%, P < 0.01) and decrease in antimicrobial-induced DILI ALF (45.8% vs. 38.5%, P = 0.03) and (ii) improved overall transplant-free survival (23.5%-38.7%, P < 0.01) while the number of patients transplanted declined (46.4% vs 33.6%, P < 0.03). DISCUSSION: DILI ALF in North America is evolving, with HDS cases rising and other categories of suspect drugs declining. The reasons for a significant increase in transplant-free survival and reduced need for liver transplantation over time remain unclear but may be due to improvements in critical care, increased NAC utilization, and improved patient prognostication.

Indexed as

Chemical and Drug Induced Liver InjuryLiver Failure, AcuteLiver TransplantationAdultHumansNorth AmericaRegistriesUnited States

Identifiers

PMID35081550
PMCPMC10668505
OpenAlexW4210569072

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.