E-ISSN 2148-5607
Liver - Original Article
Predictors of poor outcomes in 488 patients with herb-induced liver injury
1 Integrative Medical Center, 302 Military Hospital, Beijing, China  
2 China Military Institute of Chinese Medicine, 302 Military Hospital, Beijing, China  
3 Kassel University School of Electrical Engineering and Computer Science, Kassel, Germany  
4 Institute of Industrial, Environmental and Social Medicine, Goethe University School of Medicine, Frankfurt, Germany  
Turk J Gastroenterol 2019; 30: 47-58
DOI: 10.5152/tjg.2018.17847
Key Words: Drug-induced liver injury, herbal hepatotoxicity, mortality, chronicity, prognosis

Background/Aims: Herb-induced liver injury (HILI) can lead to chronic liver injury, liver transplantation, or even death. This study aimed to identify the predictors of poor HILI outcomes, especially chronic HILI.


Materials and Methods: Clinical data of 488 patients with HILI were retrospectively analyzed from a Chinese center between January 2010 and January 2014. Logistic regression and C-statistic were used to identify risk factors and prognostic models for HILI outcomes.


Results: In all patients, 69 (14.1%) developed chronic HILI, and 20 (4.1%) died due to liver injury or underwent liver transplantation. To predict the fatal HILI prognosis, the model for end-stage liver disease (MELD) with a C-statistic of 0.981 (95%CI 0.968-0.995) was better than Hy’s law (C-statistic 0.569; 95%CI 0.449-0.689). The latency, course of peak alanine aminotransferase decreasing ≥50% after discontinuation of herb application, peak triglyceride value, and platelet count at liver injury onset were identified as independent risk factors for chronicity with the adjusted odds ratios of 1.268 (95% confidence interval [CI] 1.034-1.554), 2.303 (95%CI 1.588-3.340), 0.580 (95%CI 0.343-0.978), and 0.183 (95%CI 0.091-0.368), respectively. A prognostic model for chronic HILI based on these four factors yielded the best prediction with a C-statistic of 0.812 (95%CI 0.755-0.868), compared with MELD (C-statistic 0.506; 95%CI 0.431-0.581) and Hy’s law (C-statistic 0.418; 95%CI 0.343-0.492).


Conclusion: Model for end-stage liver disease can be used to predict the fatal prognosis of HILI. A long latency, slow recovery, and low triglyceride value and platelet counts are important determinants for chronic HILI.


Cite this article as: Zhu Y, Niu M, Wang JB, et al. Predictors of poor outcomes in 488 patients with herb-induced liver injury. Turk J Gastroenterol 2019; 30: 47-58.

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