Practical guidelines for diagnosis and early management of drug-induced liver injury

Table 5 Examinations that should be performed in a patient with suspected DILI

Test	Subjects that can be evaluated
Hematological test1	Determination of the type of liver injury (the ratio of ALT and ALP)
Blood count (including eosinophils)
Biochemical test1
Aspartate aminotransferase (AST)	Possibility (e.g. Increase in eosinophil count, the existence of mixed type liver injury without any biliary disorders on imaging studies, High IgG level (> 2 g/dL) is suspicious of autoimmune hepatitis. Antibodies against hepatitis virus may be false-negative especially in the early phase of infection. Instead, measurement of viral RNA or DNA may be useful for the diagnosis. HDV (requires concomitant HBV infection) and HEV are relatively rare in advanced countries. Although, liver injury caused by EBV or CMV is also relatively rare, young patients with possible DILI should be checked for EBV or CMV).
Alanine aminotransferase (ALT)
Lactate dehydrogenase
γ-glutamyl transpeptidase (γ-GTP)
Alkaline phosphatase (ALP)
Total bilirubin (including direct and indirect bilirubin)
Albumin
Choline esterase (ChE)
Total cholesterol (Cho)
Coagulation test1
Prothrombin time international ratio (PT-INR)
Serological test1
IgG, IgA, IgM	Severity (Marked increase or decrease in white blood cell count, decrease in platelet count. Increase in bilirubin level, decrease in albumin, ChE or Cho levels. Decrease in the ratio of direct/total bilirubin (< 0.67). Prolongation of PT-INR).
Anti-nuclear antibody (ANA)
Anti-mitochondrial antibody (AMA or M2)
Viral serology
IgM anti-HA1
HBsAg1, IgM-HBc1, anti-HBc, HBV-DNA
HCV-Ab1, HCV-RNA
HDV-Ab, HDV-DNA
HEV-Ab, HEV-RNA
IgM-EBV
IgM-CMV
Imaging study
Ultrasonography (US)1

¹Tests which should be carried out first. Ig: Immunoglobulin; HA: Hepatitis A; HBsAg: Hepatitis B surface antigen; HBc: Hepatitis B core; HBV: Hepatitis B virus; HCV: Hepatitis C virus; Ab: Antibody; HDV: Hepatitis D virus; HEV: Hepatitis E virus; EBV: Epstein-Barr virus; CMV: Cytomegalovirus.