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Earlier Predictive Value: During early acute liver injury, GR activity rises significantly, with its peak appearing earlier than that of transaminases (ALT, AST), providing a more timely window for clinical intervention [4] Major liver disease guidelines from the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) emphasize the need to detect early hepatocyte stress and dysfunction, particularly in conditions like drug-induced liver injury [5,6]

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consequently, utilizing the total scores would produce equivocal findings about affective symptoms due to the influence of somatic symptoms on the total scores