BILE ACID CONJUGATION IMBALANCE FOR DIFFERENTIATING DRUG-INDUCED FROM NON-DRUG-INDUCED LIVER INJURY

Abstract

Drug-induced liver injury (DILI) remains difficult to distinguish from other forms of liver injury because conventional biochemical markers lack etiological specificity. This study evaluated whether bile acid conjugation patterns could provide additional discriminatory value. A secondary-data-based observational comparative analysis was conducted using 120 patients with DILI, 49 with non-drug-induced liver injury, and 25 healthy controls from a publicly available Mendeley source. Major bile acid measures included total, conjugated, glycoconjugated, tauroconjugated, and unconjugated bile acids together with derived ratios. Descriptive statistics, independent-samples t-tests, Pearson correlation, and simple binary logistic regression were applied. Absolute concentrations of total bile acids and major conjugated bile acid fractions were broadly similar between DILI and non-DILI groups. However, the glycine-to-taurine ratio was significantly higher in DILI, whereas the conjugated-to-unconjugated ratio was significantly lower. TSLCA, αMCA, HyoDCA, and SLCA were also significantly higher in DILI. Strong positive correlations were observed among conjugated, glycoconjugated, tauroconjugated, and total bile acids. Logistic regression further showed that the glyco/tauro ratio and conjugated/unconjugated ratio were significantly associated with DILI status. These findings suggest that relative bile acid conjugation patterns may provide more useful discriminatory information than absolute bile acid concentrations for differentiating DILI from non-DILI, although further validation in larger independent cohorts is required.