Drug-Induced Liver Injury: Mechanisms, Diagnosis, and Prevention

Drug-induced liver injury (DILI) represents a leading cause of acute liver failure worldwide and poses a significant challenge in both clinical practice and drug development. It encompasses a broad spectrum of liver dysfunctions ranging from asymptomatic elevations in liver enzymes to fulminant hepatic failure. DILI may result from predictable dose-dependent mechanisms or idiosyncratic reactions influenced by genetic, environmental, and immunological factors. In this review, we explore the underlying pathophysiological mechanisms of DILI, including mitochondrial dysfunction, oxidative stress, and immune-mediated hepatotoxicity. We also outline current diagnostic approaches based on clinical scoring systems, biomarkers, and exclusion of alternative causes. Given the lack of specific diagnostic tests, a high index of suspicion and comprehensive history-taking are crucial for early identification. Strategies for prevention include pharmacogenomic screening, improved patient education, and more stringent post-marketing surveillance of drugs. Greater understanding of mechanistic pathways and predictive biomarkers is essential to reduce DILI-related morbidity and mortality and to guide safer drug development.