Herb-induced liver injury: Systematic review and meta-analysis

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.