Herbal hepatotoxicity: Challenges and pitfalls of causality assessment methods

Table 3 Methods of causality assessments for suspected herbal hepatotoxicity

Methods of causality assessment	Specific criteria of various causality assessment methods
	Expert based	Structured	Qualitative	Quantitative	Liver specific	Liver validated
Prospective evaluation
CIOMS scale	No	Yes	No	Yes	Yes	Yes
MV scale	No	Yes	No	Yes	Yes	Yes
Naranjo scale	No	Yes	No	Yes	No	No
KL method	No	Yes	Yes	No	No	No
Ad hoc approach	No	No	No	No	No	No
Retrospective evaluation
DILIN method	Yes	Yes	Yes	No	Yes	No
WHO method	Yes	Yes	No	No	No	No
Expert opinion	Yes	No	No	No	Yes	No

Compilation of details are derived from previous reports[2,3,60-62,76-79,81,89,102]. Council for International Organizations of Medical Sciences scale (CIOMS scale) refers to both the original scale[60] and its update (Tables 5 and 6)[62]. Liver-specific and liver-validated criteria reflect hepatotoxicity criteria. Expert based criterion refers to the requirement of several experts for the actual case under consideration. MV scale: Maria and Victorino scale; KL method: Karch and Lasagna method; DILIN method: Drug Induced Liver Injury Network method; WHO method: World Health Organization method.