# The incidence of chronic drug-induced liver injury: a systematic review and meta-analysis

## TL;DR

This study estimates how often drug-induced liver injury becomes chronic, finding that about 14% of cases last more than six months.

## Contribution

The study provides the first pooled estimate of chronic drug-induced liver injury incidence using a systematic review and meta-analysis.

## Key findings

- Chronic DILI occurs in 14.09% of cases lasting more than six months.
- Antimicrobial drugs are linked to a 14.56% chronic DILI incidence.
- Long-term follow-up is needed to manage chronic DILI risks.

## Abstract

Drug-induced liver injury (DILI) is a recognized adverse drug event. Although most cases present with acute hepatic damage, evidence indicates that a proportion progress to persistent liver injury. The absence of a standardized definition for chronic DILI has contributed to significant discrepancies in reported incidence rates across clinical studies. This meta-analysis aims to determine the pooled incidence of chronic DILI, providing robust epidemiological evidence.

This meta-analysis was conducted in accordance with the PRISMA and MOOSE guidelines. A systematic search was conducted in PubMed, Web of Science, Embase and Cochrane Library databases from their respective inception dates to 11 July 2025. The quality of cohort studies was assessed using the NOS. A random-effects model was used to calculate the pooled incidence of chronic DILI, expressed as corresponding 95% confidence intervals (CIs). Subgroup analyses were performed to explore potential sources of heterogeneity. Publication bias was assessed and sensitivity analyses were conducted. All statistical tests were two-tailed, and a P value <0.05 was considered statistically significant.

A total of 24 studies were included in the final analysis. The pooled incidence of chronic DILI (based on a duration of liver injury lasting more than 6 months without distinguishing the suspected drugs) was 14.09% (95% CI: 10.35%–18.29%; I

2
= 80.76%). Four studies that reported the incidence of chronic DILI based on a 12-month follow-up (without distinguishing causative drugs) showed a pooled incidence of 7.95% (95% CI: 5.16%–11.24%; I

2
= 54.8%). The pooled incidence of chronic DILI attributed to antimicrobial drugs (6-month follow-up) was 14.56% (95% CI: 10.86%–18.65%; I

2
= 0%).

Chronic DILI accounts for a clinically certain proportion of DILI cases. Greater emphasis should be placed on the long-term management and follow-up of patients with DILI to mitigate the risk of chronic progression.

https://inplasy.com, identifier INPLASY202580021.