Table 3.
Characteristics of the 14 main herbs that induced-liver injury
| Generic or trade names |
Latin name |
n
|
Age (mean) |
Sex (male) (%) |
Country/territory (%) |
Symptoms (%) |
AST (mean) |
ALT (mean) |
ALP (mean) |
GGT (mean) |
BT (mean) |
BD (mean) |
Biopsy (%) |
HILI patterns (%) |
Maira and Victorino score (mean) |
Treatment (%) |
Clinical outcome (%) |
| He-Shou-Wu; Fo-ti; Shou Wu Pian | Polygonum multiflorum | 91 | 46 | 47 (51.6) | China (54.9), South Korea (28.5) | Jaundice (80), choluria (17.7), fatigue (15.5), hepatomegaly (13.3) | 1279 | 1511 | 222 | 264 | 10.8 | 6.3 | 20 (31.7) | Hepatocellular (72.5), cholestatic (18.6), mixed (8.7) | 8 | Adenosylmethionine (12.3), glutathione (12.3), glycyrrhizin (12.3), polyene phosphatidylcholine (12.3), supportive care (45.8) | Recovery (93.4), chronification (3.3), died (3.3) |
| Green tea extract | Camellia sinensis | 90 | 44 | 22 (24.4) | Usa (32.5), Spain (19.1), Japan (14.6) | Jaundice (61.4), fatigue (30.4), nausea (27.5), abdominal pain (26) | 1715 | 1870 | 330 | 271 | 12.8 | 9.2 | 36 (60) | Hepatocellular (78.8), cholestatic (8.8), mixed (11.1) | 9 | Liver transplantation (10.5), corticoid (9.4), acetylcysteine (3.1), supportive care (45.8), udca (3.1), supportive care (69.4) | Recovery (91.7), chronification (1.1), died (7) |
| Kava kava | Piper methysticum | 62 | 43 | 15 (24.1) | Germany (65), United States (21.6), Spain (3.3) | Jaundice (86.8), nausea (47.8), fatigue (34.7) | 1206 | 1605 | 310 | 284 | 19 | 10 | 36 (69.2) | Hepatocellular (77.4), cholestatic (9.6), mixed (8) | 8 | Liver transplantation (23.9), corticoid (4.2), suportive care (57.7) | Recovery (91.9), died (8) |
| Greater celandine | Chelidonium majus | 48 | 49 | 8 (17) | Germany (81.2), Italy (8.3) | Jaundice (34.2), choluria (31.4), pruritus (28.5), nausea (27.7) | 631 | 1109 | 321 | 236 | 11.5 | 6.9 | 34 (79) | Hepatocellular (72.9), cholestatic (6.2), mixed (20.8) | 10 | Udca (6.1), corticoid (4), glutathione (2), supportive care (87.7) | Recovery (97.9), died (2) |
| Germander | Teucriumchamaedrys | 35 | 49 | 11 (31.4) | France (28.5), Greece (22.8), United States (14.2) | Jaundice (77.1), nausea (17.1), choluria (17.1), abdominal pain (17.1) | 1091 | 1127 | 251 | 183 | 13.7 | 9.1 | 13 (40.6) | Hepatocellular (94.2), mixed (5.7) | 12 | Udca (15.7), vit K (13.1), liver transplantation (5.2), supportive care (65.7) | Recovery (97.1), died (2.8) |
| Skullcap | Scutellaria spp. | 35 | 54 | 9 (25.7) | United States (45.7), Australia (14.2), Scotland (11.4) | Jaundice (68), nausea (15.3), choluria (20) | 859 | 1234 | 227 | 359 | 14 | NA | 12 (67.7) | Hepatocellular (74.2), CHOLESTATIC (5.7), MIxed (14.2) | 9 | Liver transplantation (11.1), corticoid (2.7), udca (2.7), supportive care (77.7) | Recovery (85.7), died (14.2) |
| Kratom | Mitragyna speciosa | 33 | 36 | 20 (62) | United States (75), Canada (6.2), Sweden (6.2) | Jaundice (70), choluria (53.3), abdominal pain (43.5), nausea (23.3), fatigue (23.3) | 1125 | 957 | 304 | 258 | 11.7 | 11.3 | 11 (39.2) | Hepatocellular (45.4), cholestatic (27.2), mixed (21.2) | 11 | Acetylcysteine (12.7), udca (7.6), corticoid (5.1), liver transplantation (5.1), supportive care (48.7) | Recovery (90.6), died (9.3) |
| Tusanqi or Jusanqi | Gynura segetum | 29 | 54 | 14 (48.2) | China (75.8), Hong Kong (20.6), New Zeeland (3.4) | Ascites (100), hepatomegaly (86.9), jaundice (26) | 469 | 460 | NA | NA | 1 | 0.5 | 1 (50) | Sinusoidal obstruction syndrome (100) | 4 | Glutathione (6.6), antibiotics (6.6), furosemide (6.6), supportative care (80) | Recovery (50), chronification (22.2), died (27.7) |
| Garcinia cambogia; Malabar tamarind | Garcinia gummi-gutta | 29 | 45 | 3 (10.3) | United States (39.2), Italy (35.7) | Abdominal pain (56), jaundice (44), nausea (40), vomiting (24), fatigue (16) | 1918 | 1927 | 243 | 249 | 10.9 | 7.5 | 12 (50) | Hepatocellular (86.2), cholestatic (10.3), mixed (3.4) | 10 | Liver transplantation (20.6), acetylcysteine (10.3), corticoid (3.5), supportive care (65.5) | Recovery (96.6), died (3.4) |
| Ma huang | Ephedra sinica | 27 | 44 | 8 (32) | United States (68), South Korea (12), United Kingdom (8) | Abdominal Pain (72.7), nausea (63.6), jaundice (54.5), fatigue (45.4), hepatomegaly (36.3) | 3173 | 2092 | 188 | 161 | 12.5 | NA | 10 (55.5) | Hepatocellular (96), mixed (4) | 9 | Liver transplantation (19.2), corticoid (3.8), urine alkalization (3.8), hemodialysis (3.8), diuretics (3.8), suportive care (65.3) | Recovery (92), died (8) |
| Chaparral | Larrea tridentata | 26 | 44 | 9 (34.6) | United States (80.7), Australia (7.6), Canada (7.6) | Jaundice (84), abdominal pain (40), fatigue (36), nausea (28), pruritus (24) | 1300 | 1081 | 189 | 317 | 17.7 | 9.6 | 10 (43.4) | Hepatocellular (84.6), steatosis (15.3) | 11 | Corticoid (7.6), liver transplantation (7.6), vit K (3.8), supportive care (80.7) | Recovery (92.3), died (7.6) |
| Senna; Sene | Senna spp. | 25 | 33 | 5 (21.7) | India (24), Italy (16), Yemen (16) | Jaundice (43.4), abdominal pain (34.7), encephalopathy (20), asthenia (20), choluria (13) | 1637 | 1688 | 477 | 128 | 7.4 | 5.1 | 7 (50)) | Hepatocellular (84), cholestatic (4), mixed (12) | 10 | Antibiotics (9.6), vit K (12.9), lactulose (6.4), liver transplantation (3.2), acerylcysteine (3.2), supportive care (58) | Recovery (81.8), died (18.1) |
| Aloe Vera | Aloe vera | 22 | 50 | 5 (22.7) | South Korea (18.1), Spain (9), Usa (9) | Abdominal pain (50), jaundice (40.9), fatigue (31.8), nausea (27.2) | 1762 | 1300 | 414 | 167 | 10.1 | 8.7 | 11 (52.3) | Hepatocellular (86.3), cholestatic (4), mixed (9) | 11 | Antibiotics (4.1), liver transplantation (4.1), vit K (4.1), hemodialysis (4.1), supportive care (75) | Recovery (85.7), chronification (4.7), died (9.5) |
| Jin Bu Huan | Lycopodium serratum | 19 | 46 | 2 (10.5) | United States (73.6), Canada (10.5), Italy (10.7) | Fatigue (52.6), hepatomegaly (42.1), pruritus (36.8), jaundice (31.) | 596 | 1057 | 231 | 185 | 7.5 | NA | 6 (40) | Hepatocellular (84.2), cholestatic (5.2), mixed (10.5) | 13 | Cholestyramine (15.7), supportive care (84.2) | Recovery (100) |
ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; BT: Total bilirubin; BD: Direct bilirubin; NA: Not available; UDCA: Ursodeoxycholic acid.