CSH guidelines for the diagnosis and treatment of drug-induced liver injury

Hepatol Int. 2017 May;11(3):221-241. doi: 10.1007/s12072-017-9793-2. Epub 2017 Apr 12.


Drug-induced liver injury (DILI) is an important clinical problem, which has received more attention in recent decades. It can be induced by small chemical molecules, biological agents, traditional Chinese medicines (TCM), natural medicines (NM), health products (HP), and dietary supplements (DS). Idiosyncratic DILI is far more common than intrinsic DILI clinically and can be classified into hepatocellular injury, cholestatic injury, hepatocellular-cholestatic mixed injury, and vascular injury based on the types of injured target cells. The CSH guidelines summarized the epidemiology, pathogenesis, pathology, and clinical manifestation and gives 16 evidence-based recommendations on diagnosis, differential diagnosis, treatment, and prevention of DILI.

Keywords: Clinical type; Diagnosis; Differential diagnosis; Drug-induced liver injury; Epidemiology; Pathogenesis; Pathology; Prevention; Recommendations; Treatment.

Publication types

  • Editorial

MeSH terms

  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / toxicity
  • Anti-Infective Agents / adverse effects
  • Anti-Infective Agents / toxicity
  • Chemical and Drug Induced Liver Injury / epidemiology*
  • Chemical and Drug Induced Liver Injury / pathology
  • Chemical and Drug Induced Liver Injury / physiopathology
  • Chemical and Drug Induced Liver Injury / prevention & control
  • China / epidemiology
  • Cholestasis / chemically induced*
  • Cholestasis / complications
  • Cholestasis / pathology
  • Diagnosis, Differential
  • Dietary Supplements / adverse effects*
  • Dietary Supplements / toxicity
  • Drugs, Chinese Herbal / adverse effects
  • Female
  • Guidelines as Topic
  • Humans
  • Incidence
  • Liver Diseases / epidemiology*
  • Liver Diseases / pathology
  • Liver Diseases / physiopathology
  • Liver Diseases / therapy
  • Male
  • Prognosis
  • Risk Factors
  • Severity of Illness Index


  • Anti-Bacterial Agents
  • Anti-Infective Agents
  • Drugs, Chinese Herbal