DIAGNOSTIC TOOLS FOR DRUG-INDUCED LIVER INJURY IN ACUTE LIVER FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS
DOI:
https://doi.org/10.61182/rnavmed.v11n2a5Keywords:
DILI, Acute liver failure, RUCAM score, DILIN score, NMPA scoreAbstract
Objective: To assess the accuracy and validity of diagnostic tools for DILI in patients with acute liver failure, comparing their sensitivity, specificity, and clinical utility.
Methods: A systematic review and meta-analysis were conducted on observational studies involving adults with acute liver failure. Three studies (563 patients) were included, analyzing the performance of the RUCAM, DILIN, and NMPA scoring systems. The main outcomes were the sensitivity, specificity, and predictive values of these tools.
Results: The DILIN system exhibited the highest sensitivity (95.1%) but a low specificity (23.9%), while NMPA excelled in specificity (99.2%) and showed a positive predictive value of 90.7%. RUCAM demonstrated an intermediate balance with a sensitivity of 90.5% and a specificity of 56%. The most common symptoms of DILI included jaundice (66%), nausea (63%), and abdominal pain (49%).
Conclusion: DILIN is effective for the early detection of DILI, though its low specificity may result in false positives. NMPA is more suitable for confirming diagnoses due to its high specificity. Integrating these tools with the development of specific biomarkers and combined diagnostic algorithms could enhance diagnostic accuracy and optimize the management of DILI in acute liver failure.
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Copyright (c) 2025 Carlos Hernán Calderón-Franco, Óscar Iván Cujiño-Ibarra, Arlen Mauricio Marquez-Galindo, Natalia Fernanda Calderón-Lopez, Diego Mauricio Aponte-Martín
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