Specific clinicopathologic findings are associated with the severity and chronicity of drug-induced liver injury among hospitalized patients

Understanding of pathologic findings associated with the severity and chronicity of drug-induced liver injury (DILI) remains limited. We explored pathologic findings associated with the severity and chronicity in a biopsy-based cohort. We reevaluated medical records and liver histology of hospitalized patients clinically diagnosed with DILI. The severity was classified into five grades; among 301 DILI patients, only eight patients presented with acute liver failure, but no one died. Grades 3–4 were associated with confluent necrosis, ductular reaction, a higher grade of cholestasis and fibrosis, whereas grades 1–2 were associated with the presence of granulomas. 244 patients achieved biochemical normalization within 6 months, 31 patients within 1 year, 17 within 2 years, and 3 within 3 years. This study demonstrated that specific histological features are associated with the severity and chronicity of DILI. Importantly, an interlobular duct loss >25% seems to be an early risk factor for continued biochemical abnormalities.