Table 2.
Baseline features of herb-induced liver injury in 936 patients
| Variable |
Patients, n = 936 (%) |
| Mean age (yr) | 42.67 |
| Sex (female) | 611 (65.2) |
| Race | |
| White | 82 (8.7) |
| Black | 9 (0.9) |
| Other | 53 (5.6) |
| Country | |
| United States | 253 (27) |
| Germany | 103 (11) |
| China | 78 (8.3) |
| Spain | 58 (6.2) |
| Italy | 50 (5.3) |
| South Corea | 40 (4.2) |
| Others | 354 (37.8) |
| Application | |
| Weight loss | 145 (15.4) |
| Psychiatry disorders | 52 (5.5) |
| Pain control | 46 (4.8) |
| Gastrointestinal disorders | 41 (4.3) |
| Skin problems | 37 (3.7) |
| Health improvement | 34 (3.6) |
| Physical improvement | 34 (3.6) |
| Sleep disorders | 24 (2.5) |
| Symptoms | |
| Jaundice | 437 (46.3) |
| Abdominal pain | 212 (22.4) |
| Nausea | 163 (17.2) |
| Hepatomegaly | 131 (13.8) |
| Fatigue | 131 (13.8) |
| Urine alteration | 127 (13.4) |
| Coluria | 120 (12.7) |
| Hematuria | 7 (0.7) |
| Vomiting | 117 (12.4) |
| Ascites | 104 (11) |
| Pruritus | 84 (8.9) |
| Stools alteration | 57 (6) |
| Clay colored | 53 (5.6) |
| Melena | 4 (0.4) |
| Anorexia | 49 (5.1) |
| Encephalopathy | 39 (4.1) |
| Asthenia | 34 (3.6) |
| Malaise | 33 (3.5) |
| Diarrhea | 33 (3.5) |
| Abdominal distension | 30 (3.1) |
| Weakness | 27 (2.8) |
| Fever | 22 (2.3) |
| Lethargy | 19 (2) |
| Hyporexia | 19 (2) |
| Splenomegaly | 17 (1.8) |
| Myalgia | 14 (1.4) |
| Altered mental status | 14 (1.4) |
| Weight loss | 13 (1.3) |
| Antibodies | |
| ANA | 48 (5) |
| ASMA | 25 (2.6) |
| AMA | 7 (0.7) |
| Anti-dsDNA | 2 (0.2) |
| cANCA | 2 (0.2) |
| Actin | 1 (0.1) |
| Anti-LKM | 1 (0.1) |
| AMA-M2 | 1 (0.1) |
| pANCA | 1 (0.1) |
| Rheumatoid factor | 1 (0.1) |
| AST (U/L) | 1324 |
| ALT (U/L) | 1462 |
| ALP (U/L) | 283 |
| GGT (U/L) | 260 |
| Total bilirubin (mg/dL) | 28.37 |
| Direct bilirubin (mg/dL) | 7.71 |
| HILI pattern | |
| Hepatocellular | 660 (70) |
| Sinusoidal obstruction syndrome | 92 (9.7) |
| Cholestatic | 80 (8.5) |
| Mix | 78 (8.3) |
| Granulomatous hepatitis | 6 (0.6) |
| Steatosis | 5 (0.5) |
| Ductopenia | 3 (0.3) |
| Nontippable | 2 (0.2) |
| Other | 10 (1) |
| Use duration (d) | 125 |
| Latency (d) | 121 |
| Stop and manifestation (d) | 1 |
| Normalization liver function (d) | 77 |
| Comorbidities | |
| Dyslipidemia | 40 (4.2) |
| Obesity | 37 (3.9) |
| Hypertension | 36 (3.8) |
| Alcohol use | 26 (2.7) |
| Hypothyroidism | 26 (2.7) |
| Osteoarthritis | 13 (1.3) |
| Psoriasis | 10 (1) |
| Anxiety | 9 (0.9) |
| Asthma | 9 (0.9) |
| Depression | 9 (0.9) |
| Smoking | 7 (0.7) |
| None | 350 (37.1) |
| Other medications | |
| Vitamins and minerals | 63 (6.6) |
| Antihypertensive | 53 (5.6) |
| NSAIDs | 45 (4.7) |
| Estrogen/progesterone | 40 (4.2) |
| Diuretics | 23 (2.4) |
| Paracetamol | 23 (2.4) |
| Statins | 23 (2.4) |
| SSRI | 17 (1.8) |
| Antibiotics | 15 (1.6) |
| Corticoid | 15 (1.6) |
| Benzodiazepine | 14 (1.5) |
| Diabetes mellitus drugs | 14 (1.5) |
| Proton pump inhibitor | 12 (1.3) |
| None | 452 (47.9) |
| Temporal relation | 26 (15.6) |
| Biopsy | 383 (40.5) |
| Viral hepatitis | |
| Hep A | 3 (0.4) |
| Hep B | 5 (0.6) |
| Hep C | 8 (0.9) |
| CMV | 2 (0.2) |
| HSV | 2 (0.2) |
| Alcoholic liver disease | 2 (0.2) |
| Bile duct obstruction | 2 (0.2) |
| Other causes | |
| Pregnancy | 3 (0.3) |
| Acute hypotension | 2 (0.2) |
| Rechallenge | 79 (8.3) |
| Previous report hepatotoxicity | 855 (88.5) |
| Causality | |
| Definitive | 22 (2.3) |
| Highly probable | 8 (0.8) |
| Probable | 122 (12.9) |
| Possible | 49 (5.1) |
| Improbable | 2 (0.2) |
| Excluded | 7 (0.8) |
| Maria and Victorino | |
| Treatment | 8.69 ± 3.93 |
| Supportive care | 699 (66.1) |
| Liver transplantation | 70 (6.6) |
| Corticoid | 39 (3.6) |
| Acetylcysteine | 29 (2.7) |
| Ursodeoxycholic acid | 28 (2.6) |
| Adenosylmethionine | 21 (1.9) |
| Glutathione | 20 (1.8) |
| Vitamin K | 18 (1.6) |
| Glycyrrhizin | 18 (1.6) |
| Polyene phosphatidylcholine | 18 (1.6) |
| Antibiotics | 17 (1.5) |
| Cholestyramine | 4 (1.1) |
| Outcome | |
| Recovery | 782 (82.8) |
| Chronicity | 14 (1.5) |
| Death | 98 (10.4) |
ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; Hep: Hepatitis; CMV: Cytomegalovirus; HSV: Herpes simplex virus.