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Updated: Oct 19, 2025

Field Identification of Matricaria chamomilla using a Portable qPCR System
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Causality imputation between herbal products and HILI: An algorithm evaluation in a systematic review

Pedro Felipe Soares1, Maria Tereza Calchi Fanti Fernandes1, Andréia de Santana Souza2

  • 1School Medicine of Bahia- University Federal of Bahia, Av. Rector Miguel Calmon, S/N - Vale do Canela, 40110-100, Salvador - BA, Brazil.

Annals of Hepatology
|September 23, 2021
PubMed

Insights

The Roussel Uclaf Causality Assessment Method (RUCAM) is the primary algorithm for assessing Herb-Induced Liver Injury (HILI). Most HILI patients are female, presenting with jaundice, and the condition is often reversible.

Area of Science:

  • Hepatology
  • Clinical Pharmacology
  • Toxicology

Background:

  • Drug-Induced Liver Injury (DILI) causality scales may not apply to Herb-Induced Liver Injury (HILI).
  • Understanding HILI patient profiles and causality assessment is crucial for clinical practice.

Purpose of the Study:

  • To determine the clinical and demographic profile of patients with HILI.
  • To identify the main algorithmic scales used for HILI causality assessment.

Main Methods:

  • Systematic review of articles (1979-2019) in English, Spanish, or Portuguese.
  • Inclusion of human studies related to HILI.
  • Qualitative and quantitative statistical analysis.

Main Results:

  • 203 HILI reports analyzed from 60 articles.
  • 59.9% of patients were female, with an average age of 45.8 years.
  • Jaundice was the most frequent symptom; hepatocellular injury was most common.
  • RUCAM was used in 72.3% of cases for causality assessment.
  • 3.0% of cases were severe, and 7.6% were fatal or required transplantation.

Conclusions:

  • RUCAM is the predominant algorithm for HILI causality assessment.
  • HILI predominantly affects females, with jaundice as a key symptom.
  • HILI is frequently reversible.

Keywords:
HILIHerbal productsLiver injuryMedicinal herbsRUCAM

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