| Title: |
Lipofuscinosis as a novel discriminating feature for drug-induced liver injury from autoimmune hepatitis. |
| Authors: |
Weber, Sabine; Erhardt, Franziska; Neumann, Jens; Allgeier, Julian; Saka, Didem; Donga, Nirali; Mircheva, Izabel; Balakumar, Rochell; Lange, Christian M.; Gerbes, Alexander L. |
| Source: |
Scandinavian Journal of Gastroenterology; Aug2025, Vol. 60 Issue 8, p820-826, 7p |
| Subject Terms: |
LIPOFUSCINS; AUTOIMMUNE hepatitis; MULTIVARIATE analysis; LIVER biopsy; HISTOPATHOLOGY; DIAGNOSTIC errors; DIAGNOSIS; HEPATOTOXICOLOGY |
| Abstract: |
Background and objective: Differentiating drug-induced liver injury (DILI) and autoimmune hepatitis (AIH) is a diagnostic challenge. Liver biopsy is recommended in unclear cases, however, clear distinguishing patterns are unknown. We therefore aimed to further identify histopathological features that can discriminate DILI from AIH. Methods: The clinical and histological data of well-characterised 136 DILI and 43 AIH patients from our prospective cohort on patients with acute liver injury and potential drug-related cause were analysed. Logistic binary regression was performed to identify models that could differentiate both two entities. Results: Histopathological findings showed high overlaps between DILI and AIH, and overall concordance between histological and clinical diagnosis was low (48.9%). While interface hepatitis, plasma cell infiltration, and portal-intralobular infiltration were favouring AIH, relevant proportions of DILI patients also presented with those features (44.1%, 46.3% and 29.2%, respectively). Interestingly, on multivariate analysis, lipofuscinosis was the only independent predictor of DILI diagnosis, showing a strong association with DILI diagnosis (odds ratio [OR] 10.8; positive predictive value [PPV] 96.2%). Moreover, logistic regression analysis showed that a model combining different histopathological features (lack of interface hepatitis, fibrosis and eosinophils together with presence of cholestasis, steatosis and lipofuscinosis) could differentiate DILI from AIH with an accuracy of 76.5% and a strikingly high sensitivity of 94.9%. Conclusions: DILI and AIH showed similar histological patterns, however lipofuscinosis was identified as a novel distinctive feature for DILI with an extraordinarily high PPV. Moreover, a model combining a variety of histological features could differentiate both entities with high sensitivity. [ABSTRACT FROM AUTHOR] |
| : |
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| Database: |
Complementary Index |