When certain medications damage the liver severely, doctors need to quickly figure out who will recover on their own and who will need a transplant or may not survive. Researchers studied 305 patients with serious drug-induced liver injury and created a simple scoring system using four easy-to-measure factors: bilirubin levels, blood clotting ability, brain function, and whether herbal supplements were involved. This new “DILI-Inpt score” was better at predicting which patients would need transplants or might die within 21 days compared to two older prediction methods. If other hospitals confirm these results, this score could help doctors make faster, better decisions about patient care.

The Quick Take

  • What they studied: Can doctors predict which patients with severe medication-caused liver damage will recover on their own versus those who need a liver transplant or might not survive?
  • Who participated: 305 adults (average age 44, mostly women) hospitalized between 1998 and 2019 with severe liver damage from medications. Most damage came from antibiotics, herbal supplements, or psychiatric drugs.
  • Key finding: A new scoring system using four simple measurements correctly predicted patient outcomes 86% of the time—better than two older prediction methods that were only 79% and 63% accurate.
  • What it means for you: If you’re hospitalized with serious drug-caused liver damage, doctors may soon have a better tool to quickly assess your situation and plan your treatment. However, this finding needs to be tested in other hospitals before it becomes standard practice.

The Research Details

Researchers looked back at medical records from 305 patients who were hospitalized with severe liver damage caused by medications between 1998 and 2019. They identified which patients recovered on their own within 21 days and which ones needed liver transplants or died. Using this information, they created a simple scoring system based on four measurements doctors already take when patients arrive at the hospital: how much bilirubin (a liver waste product) is in the blood, how well the blood clots, whether the patient shows signs of brain confusion from liver failure, and whether herbal or dietary supplements caused the damage.

They then tested whether this new scoring system could accurately predict outcomes better than two older prediction methods that doctors currently use. The new system was compared to the MELD score (which uses kidney and liver function) and King’s College Criteria (which uses age, how fast liver damage happened, and brain function).

This type of study is called a retrospective analysis because researchers looked backward at existing medical records rather than following new patients forward in time.

When patients have severe liver damage from medications, time is critical. Doctors need to quickly identify who will recover naturally and who needs urgent intervention like a liver transplant. A simple, accurate scoring system helps doctors make these life-or-death decisions faster and more confidently. This research matters because it shows a new tool that might be better than what doctors currently use.

This study has several strengths: it included a large number of patients (305), used real medical data from a well-established registry, and compared the new method directly to existing methods. However, the study looked backward at past records rather than following new patients forward, which is less powerful than a prospective study. The results need to be confirmed by other hospitals and researchers before becoming standard practice. The study was conducted at specialized liver centers, so results might not apply to all hospitals.

What the Results Show

Among the 305 patients studied, 44 had severe liver injury but still had some liver function remaining (called ALI), while 261 had complete liver failure (called ALF). Within 21 days, 110 patients (36%) recovered on their own without needing a transplant. The remaining 195 patients (64%) either needed a liver transplant (115 patients) or died (80 patients).

The new DILI-Inpt score correctly identified which patients would need transplants or might die 86% of the time. This was significantly better than the MELD score, which was correct 79% of the time, and much better than the King’s College Criteria, which was only correct 63% of the time.

The most common medications causing the damage were antibiotics (42.6% of cases), followed by herbal and dietary supplements (16%), and psychiatric medications (9.8%). The median MELD score was 32, indicating very severe liver damage. The median patient age was 44 years, and about two-thirds were women.

The study found that the presence of herbal or dietary supplement use was an important factor in the scoring system, suggesting these products may cause more severe or unpredictable liver damage than other medications. The four components of the new score—bilirubin level, blood clotting ability, brain function status, and herbal supplement involvement—were all independently important for predicting outcomes. Patients with higher scores had much lower chances of spontaneous recovery.

The MELD score has been the standard tool for predicting outcomes in liver disease for many years, but it was originally developed for patients with chronic liver disease, not acute medication-induced damage. The King’s College Criteria was developed specifically for acute liver failure but appears to be less accurate than the new DILI-Inpt score. This research suggests that a scoring system specifically designed for drug-induced liver injury performs better than general liver failure prediction tools.

This study looked backward at medical records rather than following new patients forward, which is less reliable. All patients were treated at specialized liver centers, so results might not apply to regular hospitals. The study used data from 1998-2019, so some treatment approaches may have changed since then. The new score needs to be tested in other patient groups and hospitals before doctors can confidently use it everywhere. The study didn’t explain why herbal supplements were included as a separate factor, which might limit how useful the score is in different situations.

The Bottom Line

If you’re hospitalized with severe drug-induced liver damage, ask your doctors if they can use the DILI-Inpt score to help predict your outcome. This score appears promising (moderate to high confidence based on this study), but it’s not yet standard practice everywhere. The most important thing is to identify and stop taking the medication that caused the damage as soon as possible. This research suggests doctors should pay special attention to liver damage from herbal and dietary supplements, which may be more dangerous than previously thought.

This research is most relevant to people hospitalized with severe liver damage from medications, their families, and their doctors. It’s particularly important for people who take antibiotics, herbal supplements, or psychiatric medications. This doesn’t apply to people with chronic liver disease or mild medication side effects. Patients with liver damage from alcohol or viruses should discuss whether this score applies to them with their doctors.

The 21-day timeframe in this study is critical—outcomes were determined within three weeks of hospitalization. If you’re hospitalized with drug-induced liver damage, your doctors will likely know within a few days whether you’re recovering on your own or will need a transplant. The DILI-Inpt score would be used immediately upon admission to help guide urgent medical decisions.

Want to Apply This Research?

  • If you’re recovering from drug-induced liver injury, track your bilirubin levels, INR (blood clotting measure), and any signs of confusion or brain fog weekly. Record which medications you’re taking and when you stopped the offending drug. This data helps your doctor monitor your progress and predict recovery.
  • Stop taking any medication suspected of causing liver damage immediately (with doctor approval). Avoid all herbal supplements and dietary products until your liver has fully recovered and your doctor approves their use. Keep a detailed list of all medications and supplements you take to help identify which one caused the damage. Schedule regular blood tests to monitor liver function during recovery.
  • For the first month after hospitalization, get blood work done weekly to track bilirubin, INR, and liver enzymes. After one month, switch to monthly testing if improving. Keep a symptom diary noting any confusion, yellowing of skin, dark urine, or unusual bleeding. Share this information with your hepatologist (liver specialist) at each visit to ensure your recovery is on track.

This research describes a new medical tool that is not yet standard practice everywhere. If you have been hospitalized with severe liver damage from medications, discuss the DILI-Inpt score with your liver specialist to see if it applies to your situation. Never stop taking prescribed medications without talking to your doctor first, even if you suspect they’re causing liver damage. This information is educational and should not replace professional medical advice. Always consult with qualified healthcare providers about your specific condition and treatment options.