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[Analysis of Clinical Characteristics in 595 Patients with Herb-induced Liver Injury]
Insights
Herb-induced liver injury (HILI) is a significant concern, with Chinese herbs frequently causing liver damage, particularly hepatocellular injury. Improved monitoring systems are crucial for managing herbal hepatotoxicity and preventing severe outcomes like liver failure.
Area of Science:
- Hepatology
- Pharmacology
- Traditional Chinese Medicine
Background:
- Herb-induced liver injury (HILI) poses a growing clinical challenge.
- Understanding the clinical spectrum of HILI is essential for timely diagnosis and management.
- Chinese herbal medicine use is widespread, necessitating investigation into associated hepatotoxicity.
Purpose of the Study:
- To characterize the clinical features of herb-induced liver injury (HILI).
- To identify common causative Chinese herbs and patterns of liver injury.
- To assess the severity and outcomes of HILI.
Main Methods:
- Retrospective analysis of 595 inpatients diagnosed with HILI.
- Data collected included clinical conditions, medical history, biochemical indices, and prognosis.
- Roussel Uclaf Causality Assessment Method (RUCAM) scores were used to assess causality.
Main Results:
- HILI predominantly affected females (71.1%) aged 41-50 years.
- Hepatocellular injury was the most common pattern (85.9%), with a median onset of 30 days after starting herbs.
- Polygonum multiflorum, Psoralea corylifolia, and Corydalis ambigua were frequently implicated; 74.1% had a 'very possibly' association with Chinese herbs via RUCAM.
Conclusions:
- Chinese herbs can lead to severe liver injury (LI), including liver failure and death.
- There is a critical need for increased awareness of herbal hepatotoxicity.
- Enhancing the monitoring system for HILI is imperative for patient safety.
Objective:
To observe clinical characteristics of herb-induced liver injury (HILI).
Methods:
General conditions, medical history, clinical manifestations, biochemical indices, prognosis, and Roussed Uclaf Causality Assessment Method (RUCAM) scores were retrospectively analyzed in 595 inpatients at 302 Military Hospital between January 2009 and January 2014.
Results:
There were 423 cases (accounting for 71.1%) were females with multiple onset age ranging 41 to 50 years old. The median time from starting Chinese herbs to the occurrence of liver injury (LI) was 30 days (15-75 days), and 511 cases (85.9%) were classified as hepatocellular injury. Chinese herbs inducing HILI were mainly used for skin disease (102 cases, 17.1%), osteoarticular disease (57 cases, 9.6%), and gastrointestinal disease (49 cases, 8.2%), covering 207 kinds of Chinese patent medicines. Polygonum multiflorum, Psoralea corylifolia, and Corydalis ambigua were often seen in Chinese prescriptions. In RUCAM scoring, 451 HILI patients (accounting for 74.1%) were very possibly associated with Chinese herbs. Liver failure occurred in 47 HILI patients (accounting for 7.9%), cirrhosis in 45 patients (accounting for 7.6%), chronic HILI in 80 patients (accounting for 13.4%), 27 (4.5%) died, and only 2 (0.3%) underwent liver transplantation.
Conclusions:
Chinese herbs could cause LI or even death. Attention should be paid to herbal hepatotoxicity and improving monitoring system of HILI.
