Factors influencing severity and various clinical indexes in herb-induced liver injury: An updated bibliometric...

The global rise in herbal medicine (HM) utilizes as an alternative treatment has corresponded with a rise in herb-induced liver injury (HILI). Although numerous systematic reviews existed, their generalizability is limited, and factors associated with HILI remain unclear.

To comprehensively summarize HILI cases reported in English language literature and to investigate the association between potential factors related to HM use and the severity of liver injury.

A total of 643 patients from 382 studies were included. Global HILI cases rose markedly between 2002 and 2011. Weight management was the most common reason for HM use. Single-herb product users were more likely to develop mild injury compared with mixed-product users. Supplementary product use was associated with higher chances for having cholestasis. Females (64.9 %) were generally older at onset and had longer herb use durations, while males showed higher Gamma-Glutamyl Transferase (GGT) levels. Older patients tended to have less severe injury, though with elevated GGT and prolonged herb use. Race significantly influenced International Normalized Ratio, total bilirubin, and overall severity.

This study highlights sex, age, race, usage patterns, liver function markers (GGT, INR, TBL), and HM type (herbal preparations and constituents) as key factors in HILI diagnosis and management. Further studies are warranted to confirm these associations.