ArticleCureus2026
Anti-tubercular Drugs Dominate Drug-Induced Liver Injury in Northern India: An Observational, Cross-Sectional Study of 100 Cases Using the Revised Electronic Causality Assessment Method (RECAM) and Drug-Induced Liver Injury Network (DILIN) Criteria.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDrug-induced liver injury (DILI) is a major cause of acute liver failure in India, yet prospective data from northern India are rare. We analyzed drugs, clinical patterns, severity, and risk factors associated with DILI in a tertiary care hospital.
methodsThis observational, cross-sectional study (IEC letter no. XXII-PGTSC-IIA/P9; March 2023-February 2024) included 100 patients with DILI (alanine transaminase (ALT)≥5×upper limit of normal (ULN) or ALT≥3×ULN plus bilirubin≥2×ULN). Causality assessment was performed using the Revised Electronic Causality Assessment Method (RECAM), and severity was classified by the Drug-Induced Liver Injury Network (DILIN) scale. Multivariate logistic regression identified predictors of moderate-to-severe DILI (grades 3-5).
resultsAverage age was 52.6±16.1 years, with 51% male. Anti-tubercular therapy (ATT) was implicated in 39 (39%) cases, antibiotics in 20 (20%), antiepileptics in 17 (17%), and complementary/alternative medicines (CAM) in 7 (7%) cases. Hepatocellular injury was the most common pattern, observed in 46 (46%) patients, followed by mixed injury in 36 (36%) and cholestatic injury in 18 (18%) patients. Regarding severity, 58 (58%) patients had Grade 1+, 19 (19%) had Grade 2+, 15 (15%) had Grade 3+, 6 (6%) had Grade 4+, and 2 (2%) had Grade 5+ injury. Hypertension (adjusted odds ratio (aOR) 4.14; 95% CI 1.65-57.40), diabetes (aOR 2.18; 95% CI 1.30-10.80), and CAM use (aOR 1.80; 95% CI 1.20-7.32) were independently associated with moderate-to-severe DILI. No clinical variable significantly predicted injury pattern.
conclusionsATT remains the foremost DILI trigger in northern India. Metabolic comorbidities and CAM use were associated with increased severity. RECAM-guided causality and DILIN grading enhance bedside risk stratification.
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