Angiotensin-Converting Enzyme Inhibitor-Drug Induced Liver Injury: Clinical Features and Diagnostic Features - A Systematic Review of Current Reported Cases.

BACKGROUND/AIMS: Angiotensin-converting enzyme Inhibitor induced liver injury (ACEi-ILI) is a rare and frequently underrecognized condition. Its nonspecific gastrointestinal symptoms could lead to missed diagnoses, unnecessary procedures, and inappropriate treatments. Due to the scarcity of studies, we conducted a systematic review to summarize the clinical characteristics, diagnostic approach, and factors predicting delayed recovery.

METHODS

Electronic databases including MEDLINE, OVID, and EMBASE were used to identified eligible studies from inception to January 2025. Eligible cases were required to have a clear diagnosis of ACEi-ILI. Descriptive analysis and Kaplan Meier analysis were used to identify factors, outcomes and recovery time. The protocol was preregistered (PROSPERO: 640521).

RESULTS

Our systematic review included 54 eligible studies, comprising 60 ACEi-IAE cases with a mean age of 58 years old, and 43% were male. The majority came from the United States (27%). Patients were presented with 61% of jaundice. The median recovery time was 6 weeks after discontinuing ACEi. Diagnostic criteria were proposed and summarized based on the findings.

CONCLUSIONS

Clinicians should be aware of ACEi-induced liver injury, particularly in ACEi users with non-specific jaundice. Implementing our proposed diagnostic criteria is recommended to prevent unnecessary investigation and inappropriate treatment.