The study is the result of collaboration between the IDIBAPS Viral, genetic and immune-mediated liver diseases research group, with Xavier Forns as the senior author and Anna Pocurull as the first author, and the Primary healthcare transversal research group led by Antoni Sisó-Almirall.
Drug-induced liver toxicity is a rare but potentially serious adverse reaction. However, most of the available information comes from hospitalized patients, and its true incidence in primary care is poorly understood. To address this issue, the research team prospectively followed a population of 91,798 adults treated at three primary care centres in Barcelona.
“We wanted to know the real incidence of this complication in an environment where many medications are prescribed and where the first signs often appear in routine blood tests,” explains Xavier Forns.
The team implemented an alert system that was automatically triggered when blood tests detected certain abnormalities in liver enzymes. Each identified case was subsequently reviewed by hepatology specialists to determine the cause. During the two-year study, 20 confirmed cases of drug-induced liver toxicity were detected.
The results show that the main medications responsible for liver damage were analgesics, statins, and dietary and herbal supplements. All the detected cases were mild and resolved completely after the causative medication was stopped, without any need for hospitalization. “The combination of an automatic alert system and the expert review allowed us to identify cases that would probably have gone unnoticed,” explains Forns.
Anna Pocurull explains that elevated transaminase levels up to five times above normal values was the most useful marker for identifying possible cases of liver toxicity.
For Antoni Sisó-Almirall, the results have a potential application in clinical practice: “The implementation of these alert systems in primary care could facilitate a faster detection of drug toxicities and allow action to be taken before complications arise. This translates into safer care for patients.”
Study of reference
Anna Pocurull et al. Incidence of Drug-Induced Liver Injury in the Urban Primary Care Setting. Clinical Gastroenterology and Hepatology. 2026. https://doi.org/10.1016/j.cgh.2026.06.014
