Clinicopathophysiological characteristics of drug-induced liver injury caused by herbal and dietary supplements

Abstract

Abstract: Objective To investigate the clinicopathological features of patients suffering from drug-induced liver injury (DILI) triggered by herbal and dietary supplements(HDS), with a view to enhance diagnostic accuracy and treatment efficacy.Methods Between July 2017 and August 2022, a total of 214 patients were admitted to the Department of Gastroenterology and Hepatology at our institution with a confirmed diagnosis of DILI. The patient demographic consisted of 115 males and 99 females, aged (58.4±9.2) years. Diagnoses adhered to the exclusionary criteria for DILI set forth by drug-induced liver disease study group of Hepatology Branch of Chinese Medical Association. Patients were stratified into two cohorts based on the causative agents: those who had taken TCM preparations and those who had consumed dietary supplements. The clinicopathological features of both groups were then comparatively analyzed. Results Of the 214 DILI cases studied,, the primary causaitve agents were anti-tuberculosis drugs(28.5%, n=61), traditional Chinese medicine preparation(22.9%, n=49), dietary supplements(16.8%, n=36), non-steroidal anti-inflammatory drugs(9.3%, n=20), antibacterial drugs(5.6%, n=12), and antipsychotics(5.6%, n=12). Upon comparative analysis of patients affected by DILI from traditional Chinese medicine, dietary supplements, and other categories(non-TCM and non-dietary supplements) we found statistically significant differences in drug latency, duration of medication, initial ALT, ALP levels, peak ALP, TBil, MELD score, occurrences of jaundice, and acute liver failure (P<0.05). Ultraspund-guided liver biopsy were performed on 11 patients from the TCM group and 27 from the dietary supplement groups Histopathological features included portal vein inflammation(n=17), lobular inflammation(n=13), interfacial hepatitis(n=16), focal necrosis(n=9), bridging necrosis(n=7), hepatic fibrosis(n=9), liver cirrhosis(n=2), cholestasis(n=7), fatty degeneration(n=5), balloon-like degeneration(n=7), eosinophil infiltration(n=5), and autoimmune hepatitis-like features(n=7). No statistically significant difference was observed in histopathological characteristics between the TCM and dietary supplement-induced DILI groups(P>0.05). Conclusion Compared with non-HDS-induced DILI, HDS-associated DILI exhibits more detrimental effects on liver function indexes and is asscociated with a higher incidence of complications. Notably, the severity of DILI is especially pronounced when triggered by TCM preparations. Enhancing public awareness about the potential risks associated with TCM preparations and dietary supplements, as well as minimizing their consumption, can serve as effective strategies ofr both the prevention and mitigation of DILI.

Key words: Drug-induced liver injury, Herbal and dietary supplements, Liver function

LIU Hua-qing, XIE Ya-ge, XU Yin-yin. Clinicopathophysiological characteristics of drug-induced liver injury caused by herbal and dietary supplements[J]. Chinese Hepatolgy, 2023, 28(9): 1097-1100.

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