Diagnostic value of drug withdrawal observation in drug-induced liver injury: A retrospective study

This study aims to assess the diagnostic value of drug withdrawal for drug-induced liver injury (DILI). Seventeen cases of suspected DILI were retrospectively analyzed at the time of initial diagnosis. Pertinent patient demographics such as gender, age, suspected causative drugs, initial serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) levels, and additional clinical parameters were documented. Subsequently, the suspected drugs were discontinued without the administration of liver-protective interventions, and the hepatic function of the patients was reassessed weekly. Based on the criteria of whether serum ALT/AST levels decreased by more than 50% from their respective baseline values after 1 week, patients were categorized into either the rapid decline group or the non-rapid decline group. This observation period was extended for 4 weeks, succeeded by a subsequent follow-up period of 4 weeks. Most patients recovered liver function within 3 weeks after drug withdrawal. The rapid decline group (12/12) recovered fully, compared to 4/5 in the non-rapid group. Liver enzyme levels (ALT/AST) differed significantly between groups over 4 weeks, with the rapid group showing a larger initial AST drop. All other factors like age and gender were similar. The time to disease recurrence was also comparable. A high DILI probability was confirmed in 16 of the 17 suspected cases, indicating a 94.11% diagnostic accuracy for DILI. In conclusion, this retrospective analysis underscores the potential of drug withdrawal as an effective management strategy for suspected DILI. The findings reveal that the cessation of suspected causative drugs, without the administration of liver-protective treatment, leads to recovery in hepatic function, as evidenced by the normalization of serum ALT and AST levels, contributing to the diagnosis of DILI.