Abstract: Objective To explore the similarities and differences of clinical characteristics between the liver injuries induced by herbal and dietary supplements (HDS) and by Western medicine.Methods The clinical data of 596 patients with drug-induced liver injuries (DILI) who were hospitalized in Beijing Friendship Hospital, Capital Medical University from January 2009 to January 2019 were retrospectively analyzed. According to the types of drugs to induce liver injuries, the patients were divided into (1) HDS group (N=348, 58.4%); (2) Western medicine group (N=137, 23.0%); (3) Combination group (i.e., taking HDS and western medicine simultaneously) (N=111, 18.6%). The demographic characteristics, clinical presentation, types of liver injuries, liver biochemistries, immunoglobulin levels and clinical outcomes of patients in different groups were compared. Analysis of Variance (ANOVA) test or nonparametric tests were used for continuous variables, and Chi Square test was used for categorical variables. Bonferroni correction was used for multiple comparisons. P<0.05 was considered statistically significant. Results The top four categories of drugs to cause DILI in HDS group were health build-up products, herbs for the treatment of osteoarticular diseases, digestive and skin diseases, accounted for 62.6% in total. The top four categories drugs to cause DILI in western medicine group were antibiotics and antifungal drugs, cardiovascular system drugs, antipyretic and nonsteroidal anti-inflammatory drugs (NSAIDs), accounting for 68.6%. The most common western drugs to induce DILI in combination group were antibiotics and NSAIDs plus herbal medicine, accounting for 75.7%. The proportions of hepatocelluar injury type decreased {288 (82.8%), 85 (76.6%), 98 (71.5%), respectively}, whereas those of mixed and cholestatic types increased {60 (17.3%), 26 (23.4%), 39 (28.4%), respectively} significantly in HDS, combination and western medicine group (P=0.039). The peak levels of alanine transaminase (ALT) and aspartate transaminase (AST) of HDS group were significantly higher, whereas the peak levels of alkaline phosphatase (ALP) and glutamyl transpeptidase (GGT) were significantly lower than those of western medicine group. The peak levels of ALT, AST, ALP, and GGT in HDS, combination group and western medicine group were 688.4 (420.0, 1156.0) U/L, 694.3 (348.5, 1010.8) U/L, 495.0 (300.3, 926.0) U/L for ALT (P=0.001);507.5 (261.0, 822.0) U/L , 467.5 (158.8, 794.7) U/L, 325.5 (187.0, 677.2) U/L for AST (P=0.001); 172.0 (123.3, 235.3) U/L, 188.0 (144.6, 276.3) U/L, 186.0 (141.0, 349.3) U/L for ALP (P=0.012); and 209.0 (119.0, 350.5) U/L, 219.0 (146.5, 367.5) U/L, 289.0 (136.8, 519.8) U/L for GGT (P=0.004), respectively. The severity (P=0.986) and clinical outcomes (P=0.408) of these three groups were similar.Conclusion The top 4 categories drugs to induce liver injuries for HDS were health build-up products, drugs for the treatment of osteoarticular diseases, digestive and skin diseases. The top 3 western medicine categories to induce liver injuries included antimicrobial/antifungal drugs, cardiovascular system drugs and NSAIDs. HDS combined with NSAIDs or antibiotics were the most common combination drugs to induce liver injuries. There is no significant difference in severity and outcomes between HDS and western drugs.

Key words: Herbal and dietary supplements, Western drugs, Drug-induced liver injuries, Clinical characteristics, Prognosis