Drug-induced liver injury (DILI) can mimic all features of acute and chronic liver diseases, including autoimmune hepatitis (AIH). Both conditions exhibit similarities in serology and histology, including the presence of antinuclear antibodies (ANA), plasma cell infiltration, and interface hepatitis, making their distinction a clinical challenge. At the 58th Annual Meeting of the European Association for the Study of the Liver (EASL2023) and the EASL Congress 2023, Dr. Yanhang Gao’s team from the First Hospital of Jilin University presented a non-invasive screening tool to identify ANA-positive DILI patients with AIH-like histological features and analyzed the clinical outcomes of such patients one year after diagnosis.
While liver biopsy aids in differentiating drug-induced liver injury (DILI) from autoimmune hepatitis (AIH), it is an invasive procedure, and the high positivity of antinuclear antibodies (ANA) in DILI can lead to the overuse of liver biopsies. Therefore, this study aimed to construct a non-invasive screening tool to identify ANA-positive DILI patients with AIH-like histological features and to analyze the clinical outcomes of these patients one year after diagnosis.
This retrospective study included patients suspected of DILI with ANA positivity who underwent liver biopsy from January 2017 to December 2020. Two pathologists identified AIH-like histological features. The follow-up period was one year after DILI onset.
The study ultimately included 93 ANA-positive DILI patients, of which 17 exhibited AIH-like histological features, and 76 did not. Factors independently associated with AIH-like histological features included serum globulin [odds ratio (OR) = 1.136, 95% confidence interval (CI): 1.029–1.273; P = 0.017] and ANA titer ≥1:1000 (OR = 6.363, 95% CI: 1.296–47.444; P = 0.035).
Receiver operating characteristic (ROC) curve analysis suggested that the optimal cutoff value for identifying AIH-like histological features was 31.5 g/L for serum globulin. In ANA-positive DILI patients, serum globulin ≥31.5 g/L or ANA titer ≥1:1000 had a sensitivity of 100% and a specificity of 57% for predicting AIH-like histological features. Within one year of follow-up, the proportion of ANA-positive DILI patients with AIH-like histological features who developed AIH was higher than that of patients without AIH-like histological features (35.3% vs. 0, P < 0.001).
The study suggests that for ANA-positive DILI patients with ANA titers ≥1:1000 or serum globulin ≥31.5 g/L, liver biopsy is recommended to determine the presence of AIH-like histological features, and close follow-up is necessary for patients with such features.
Overall, this study provides a non-invasive screening tool to identify ANA-positive DILI patients with AIH-like histological features, aiding in the precise application of liver biopsies in ANA-positive DILI patients, while also reminding clinicians to closely monitor ANA-positive DILI patients with AIH-like histological features for the potential development of AIH.
Director and Professor,
First Hospital of Jilin University
TAG: EASL2023;Vioce of China;Drug-induced liver injury
