An algorithm to identify inpatients who have had an acute episode of drug induced liver injury (DILI).
Summary of drug-induced liver injury algorithm
A. Suspect DILI? (NOTE: baseline population is institution specific. See institution implementation details)
1. Liver injury AND Exposure to drug (NOTE: medications are institution specific. See institution implementation details)
2. Temporal relationship of exposure to drug and liver injury diagnosis.
o Exposure to drug within 3 months prior to liver injury diagnosis
B. Acute liver injury?
C. Does it reach the threshold to qualify as DILI?
1. ALP >=2x ULN OR ALT >= 5x ULN OR (ALT>= 3xULN AND Bilirubin >= 2x ULN)
2. Temporal relationship of laboratory measurements and acute liver injury diagnosis.
o Normal laboratory measurements prior to exposure to drug.
o Laboratory measurements reach threshold for DILI following drug administration.
D. Patients with other diagnoses (cancer, gallbladder disease, pancreatic disease, heart failure, alcohol abuse/liver damage/toxic effects, HIV infection, rheumatoid arthritis, sarcoidosis, systemic lupus, viral hepatitis, sclerosing cholangitis, chronic liver disease, organ transplantation, liver operation, death, overdose). (NOTE: excluded diagnoses are institution specific. See institution implementation details).