{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:54:13Z","timestamp":1791557653421,"version":"4.3.4"},"reference-count":31,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82270618"],"award-info":[{"award-number":["82270618"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background &amp; Aims<\/jats:title>\n                    <jats:p>Drug\u2010induced liver injury (DILI) would progress to chronicity or death. Large language models (LLMs) may enhance clinical decision\u2010making, yet their utility relative to physicians in DILI remains unclear. Therefore, we evaluated their performance in predicting DILI outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled 943 DILI patients from three centers as internal and external cohorts. Based on 12\u2010month follow\u2010up, outcomes were classified as recovery, 6\/12\u2010month chronicity, and death. LLMs (Gemini\u20102.5 Pro, GPT\u20105.1, DeepSeek\u20103.2), hepatologists (Junior, middle, senior), and models (Hy's Law, nHy's Law, MELD Score) estimated probabilities of outcomes. LLM\u2010Rules (VOTE, OR, AND) were applied to enhance stability. Model performance was assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For 6\u2010month chronicity, the senior achieved highest AUROC (0.61) with an accuracy of 70%. Gemini\u20102.5 Pro and GPT\u20105.1 yielded AUROCs of 0.60 and 0.59, respectively, outperforming junior and middle hepatologists. Gemini\u20102.5 Pro demonstrated strongest agreement with senior (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.43). LLMs all exhibited lower accuracy and specificity than hepatologists. A similar result was observed in 12\u2010month chronicity. For overall mortality, the senior achieved highest AUROC (0.87) with an accuracy of 83%. Gemini\u20102.5 Pro and GPT\u20105.1 achieved AUROCs of 0.86, outperforming junior hepatologist, Hy's Law, and nHy's Law. GPT\u20105.1 achieved strongest agreement with senior (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.25). LLM\u2010Rules demonstrated stability for predicting outcomes across cohorts. OR and AND rules improved sensitivity and specificity, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>GPT\u20105.1 and Gemini\u20102.5 Pro showed AUROCs approaching senior hepatologists for DILI outcomes with limited accuracy and specificity. LLM\u2010Rules demonstrated stable performance across cohorts with improved sensitivity or specificity, supporting the potential of multi\u2010LLM approaches as clinician\u2010supervised complementary tools.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70879","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T08:08:23Z","timestamp":1789718903000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multicenter Evaluation of Large Language Models Versus Hepatologists for Prognostic Prediction in Drug\u2010Induced Liver Injury"],"prefix":"10.1111","volume":"46","author":[{"given":"Haoshuang","family":"Fu","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9768-4346","authenticated-orcid":false,"given":"Yanan","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gangde","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin North Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuelin","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuying","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinya","family":"Zang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1053-4121","authenticated-orcid":false,"given":"Tianhui","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhuang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Wuxi Xinrui Hospital, Shanghai Jiao Tong University School of Medicine  Wuxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruidong","family":"Mo","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1704-7086","authenticated-orcid":false,"given":"Rongtao","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2582-8803","authenticated-orcid":false,"given":"Qing","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23937"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13931"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13535"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.03.006"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13435"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.10.010"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.03.038"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1353\/pbm.1968.0004"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2014.03.050"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.06.020"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365521.2014.958094"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.07.006"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1486"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.772368"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072\u2010023\u201010539\u20104"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.36483"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature14541"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.16112"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10916\u2010025\u201002192\u20101"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.70115"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2025.101579"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591\u2010024\u201003425\u20105"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2011.58"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.02.014"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.05.003"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29283"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/0168\u20108278(90)90124\u2010a"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1053\/he.2000.5852"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2023.0089"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072\u2010022\u201010405\u20109"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.2196\/53164"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70879","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/liv.70879","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70879","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:40:43Z","timestamp":1791556843000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.70879"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":31,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/liv.70879"],"URL":"https:\/\/doi.org\/10.1111\/liv.70879","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]},"assertion":[{"value":"2026-02-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70879"}}