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

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.