RUCAM in drug and herb induced liver injury: the update.
Traditional Chinese medicine (TCM) and herbal hepatotoxicity: RUCAM and the role of novel diagnostic biomarkers such as microRNAs.
The pharmacokinetic characteristics of everolimus coupled with the temporal correlation, histologic findings, and positive RUCAM and Naranjo scores point to everolimus being the likely cause of this patient's DILI.
Abbreviations CYP3A4: Cytochrome P450 3A4 AUC: Area under the curve DILI: Drug-induced liver injury CNI: Calcineurin inhibitor mTOR: Mammalian target of rapamycin RUCAM: Roussel Uclaf Causality Assessment Method NASH: Nonalcoholic steatohepatitis.
Caption: Figure 3: Roussel Uclaf Causality Assessment Method (RUCAM)  shows a causality assessment of liver injury based on 7 criteria.
The R ratio, which is the initial step in the RUCAM assessment, was 8.16 indicating a hepatocellular pattern of injury.
Teschke, "RUCAM in drug and herb induced liver injury: the update," International Journal of Molecular Sciences, vol.
So far, the universal causality assessment methods (e.g., the RUCAM
scale) still heavily rely on the exclusion of other causes of liver injury, and consequently the identification of the real risk associated with herbal DILI has been minimally addressed.
Liver injuries were categorized as hepatocellular, cholestatic, or mixed type according to the R ratio (Table 1) (Benichou 1990), and causality assessment was evaluated using R-score by the simplified Roussel Uclaf Causality Assessment Method (RUCAM) (WR and R 2008).
The definition, pattern, and causality assessment of DILI in these 11 patients were evaluated based on the CIOMS criteria and RUCAM score, and the DILI incidence rate in our study was found to be a relatively lower crude frequency 0.94% (11 cases of 1169) than previous reports (Atasoy et al.
It was found that the DILIN structured expert opinion process was more likely to assign causality to a drug than the RUCAM
vomiting, abdominal Hepatocellular (present case) pain, malaise, fatigue, and jaundice Author (year) Updated RUCAM
Number of cases [ref.] that underwent liver transplant Stevens et al.