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

Table 3 Axes and scores of four representative scales utilized for diagnosis of drug-induced liver injury

NADRPS		CIOMS/RUCAM		M&V		DDW-J
Axis	Score	Axis	Score	Axis	Score	Axis	Score
Chronological criteria		Chronological criteria		Chronological criteria		Chronological criteria
Illegibility in onset	-1 to +2	From drug intake until onset	+1 to +2	From drug intake until onset	+1 to +3	From drug intake until onset	+1 to +2
		From drug withdrawal until onset	0 to +1	From drug withdrawal until onset	-3 to +3	From drug withdrawal until onset	0 to +1
Course of the reaction
	0 to +1	Course of the reaction	-2 to +3	Course of the reaction	-3 to +3	Course of the reaction	-2 to +3
		Risk factors Age	0 to +1			Risk factors
		Alcohol (or Pregnancy)1	0 to +1			Alcohol (or Pregnancy)1	0 to +1
		Concomitant therapy	-3 to 0
Exclusion of other causes	-1 to +2	Exclusion of other causes	-3 to +2	Exclusion of other causes	-3 to +3	Exclusion of other causes	-3 to +2
		Previous information	0 to +2	Previous information	0 to +2	Previous information	0 to +1
Rechallenge	-1 to +2	Rechallenge	-2 to +3	Rechallenge	0 to +3	Rechallenge	0 to +3
Placebo response	0 to +1
Drug concentration and monitoring	0 to +1			Extrahepatic manifestations rash, fever, arthralgia, eosinophilia, cytopenia	0 to +3	Extrahepatic manifestations eosinophilia	0 to +1
Dose relationship	0 to +1
Previous exposure and cross-reactivity	0 to +1
Any objective evidence	0 to +1					DLST	0 to +2
≥ 9 Definitive		> 8 Definitive		≥ 18 Definitive		≥ 5 Definitive
5 to 8 Probable		6 to 8 Probable		14 to 17 Probable		3 to 4 Probable
1 to 4 Possible		3 to 5 Possible		10 to 13 Possible		≤ 2 Unlikely
≤ 0 Unlikely		1 to 2 Unlikely		6 to 9 Unlikely
		≤ 0 Excluded		≤ 5 Excluded

¹Cholestatic/Mixed cases; DLST: Drug lymphocyte stimulation test.