Abstract: Objective The aim of this study was to summarize the clinical features of patients with drug-induced liver injury (DILI) with underlying non-alcoholic fatty liver disease (NAFLD). Methods 31 patients with DILI with concomitant NAFLD and 52 patients with DILI alone were encountered in our hospital between January 2023 and August 2025, homestasis model assessment for insulin resistance (HOMA-IR) and fibrosis based on 4 factors(FIB-4) were calculated, and liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were detected by FibroScan 502. Results Body mass index, percentages of underlying diabetes, hyperlipidemia, hypertension and multiple medicine administration, and taking medicine time in patients with NAFLD and DILI were much greater or higher or longer than in patients with patients with DILI(all P<0.05); serum ALT and lipid levels were much higher than in those with DILI(P<0.05); HOMA-IR, FIB-4, CAP and LSM were (3.9±1.5), (2.8±0.9), (291.4±33.7)dB/m and (9.6±3.8)kPa, all much higher than [(2.7±1.1), (2.0±0.8), (257.2±14.9)dB/m and (7.1±2.5)kPa, respectively, P<0.05] in those with DILI; percentages of hepatocyte injury type, cholestasis type and mixed type were 58.1%, 19.3% and 22.6%,significantly different as compared to 80.8%, 7.7% and 11.5% in those with DILI (P<0.05); time for blood biochemical parameter recovery was 40.4(25.5,75.2)d,much longer than [27.1(18.7,45.9)d,P<0.05],hospital stay was 13.3(9.2,22.6)d,much longer than [9.4(6.5,15.7)d,P<0.05],and percentage of chronicity was 19.3%,much higher than 5.5%(P<0.05) in patients with DILI. Conclusion Patients with NAFLD and DILI should be carefully managed clinically, as they have much more underlying diseases, relatively severe manifestations and much slower recovery.

Key words: Drug-induced liver injury, Non-alcoholic fatty liver disease, Clinical features, Outcomes