Factors affecting the clinical outcomes of patients with gynura segetum induced sinusoidal obstruction syndrome

Abstract

Abstract: Objective To investigate the factors affecting the clinical outcomes of patients with gynura segetum induced hepatic sinusoidal obstructive syndrome (gynura segetum-HSOS). Methods The patients were divided into survival group (n=37) and death group (n=18) according to the 120-day clinical outcomes. The medical history, clinical manifestations, laboratory examinations, iMELD scores and treatments were analyzed. Kalpan-meier survival curve was used to analyze the relationship between the use of low molecular weight heparin sodium and 120-day prognostic of gynura segetum-HSOS patients. Cox regression analysis was used to analyze the affecting factors of patients' 120-day prognostic, and AUROC was used to analyze the predictive power of relevant factors. Results ① The daily dose and durations of patients taking gynura segetum were with huge differences. There was no significant difference between both groups in the length of main complaint, the length of gynura segetum intake and the days from taking gynura segetum to onset. ② The most common symptoms of patients with gynura segetum-HSOS were fatigue (96.36%), loss of appetite (96.36%), abdominal distension (98.18%), and reduced urine output (98.18%), and there was no statistical difference between the two groups. ③ In the death group, serum TBIL, DBIL, TBA, WBC, Hb, INR, D-D dimer levels and iMELD were significantly higher than those in the survival group, but CHOL was lower. ④ Kalpan-meier survival curve analysis showed patients treated with low molecular weight heparin sodium had a higher 120-day survival rate (P=0.0061). ⑤ The results of multivariate analyzed by Cox regression analysis revealed that reduced urine output, liver palm/spider angioma, low molecular weight heparin sodium, CHOL, Hb, iMELD were associated with clinical outcomes in patients with gynura segetum-HSOS. The AUROC of combined predictor which obtained based on the integration of iMELD, Hb, CHOL, low molecular weight heparin sodium and liver palm/spider angioma was 0.91 (95% CI: 0.83-0.99). Conclusion Application of low molecular weight heparin sodium was beneficial for the 120-day survival rate in patients with gynura segetum-HSOS. The combined predictor may be a useful predictor of the 120-day prognosis of patients with gynura segetum-HSOS.

Key words: Gynura segetum, Hepatic sinusoidal obstruction syndrome, Low molecular weight heparin sodium, Clinical outcomes

SHAO You-lin, Zhang Suo-cai, Wu Jian-ming, XIE Jing, LONG Chun-mei, ZHENG Ting-ting, LIU Long-gen. Factors affecting the clinical outcomes of patients with gynura segetum induced sinusoidal obstruction syndrome[J]. Chinese Hepatolgy, 2021, 26(10): 1170-1175.

References

[1] Xiong AZ, Shao YL, Fang L, et al. Comparative analysis of toxic components in different medicinal parts of Gynura japonica and its toxicity assessment on mice. Phytomedicine, 2019,54:77-88.
[2] 中华医学会消化病学分会肝胆疾病协作组.吡咯生物碱相关肝窦阻塞综合征诊断和治疗专家共识意见(2017年,南京).临床肝胆病杂志, 2017, 33:1627-1637.
[3] Hassan EA, Abdel AS. Creatinine modified Child-Turcotte-Pugh and integrated model of end-stage liver disease scores as predictors of spontaneous bacterial peritonitis-related in-hospital mortality: Applicable or not. J Gastroenterol Hepatol, 2015,30:1205-1210.
[4] Mohty M, Malard F, Abecassis M, et al. Revised diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in adult patients: a new classification from the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant, 2016,51:906-912.
[5] Corbacioglu S, Carreras E, Ansari M, et al. Diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in pediatric patients: a new classification from the European society for blood and marrow transplantation. Bone Marrow Transplant, 2018,53:138-145.
[6] Yang M, Ruan J, Gao H, et al. First evidence of pyrrolizidine alkaloid N-oxide-induced hepatic sinusoidal obstruction syndrome in humans. Arch Toxicol, 2017,91:3913-3925.
[7] Ma C, Liu Y, Zhu L, et al. Determination and regulation of hepatotoxic pyrrolizidine alkaloids in food: A critical review of recent research. Food Chem Toxicol, 2018,119:50-60.
[8] 覃春捷, 刘练金, 章忠明, 等. 造血干细胞移植后肝静脉闭塞病的临床分析. 中华内科杂志, 2018,57:483-486.
[9] 刘玉兰. 肝窦阻塞综合征:临床诊治面临的问题与挑战. 中华消化杂志, 2015,35:73-76.
[10] 任晓非, 诸葛宇征, 陈世耀, 等. 土三七相关肝窦阻塞综合征的全国多中心临床调研分析. 中华消化杂志, 2017,37:523-529.
[11] Coutsouvelis J, Avery S, Dooley M, et al. Defibrotide for the management of sinusoidal obstruction syndrome in patients who undergo haemopoietic stem cell transplantation. Cancer Treat Rev, 2016,50:200-204.
[12] 王轶, 诸葛宇征, 张峰, 等. 土三七致肝小静脉闭塞病治疗的单中心回顾性研究. 中华消化杂志, 2016,36:811-815.
[13] Hermie L, Dhondt E, Vanlangenhove P, et al. Model for end-stage liver disease score and hemodynamic instability as a predictor of poor outcome in early transjugular intrahepatic portosystemic shunt treatment for acute variceal hemorrhage. Eur J Gastroenterol Hepatol, 2018, 30:1441-1446.
[14] Luca A, Angermayr B, Bertolini G, et al. An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis. Liver Transpl, 2007,13:1174-1180.