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A Single‐Center Experience on Outcomes of Complementary and Alternative Medicine Use Among Patients With Cirrhosis
Open accessAbstract
Drug‐induced liver injury (DILI) due to complementary and alternative medicine (CAM) use is on the rise throughout the world by patients looking for “safer” alternatives. However, data on acute‐on‐chronic liver failure (ACLF) due to CAM are lacking. In a large cohort of patients with cirrhosis, we retrospectively studied CAM‐related health‐seeking behavior and attempted to identify those who developed possible CAM‐DILI‐related ACLF. In this study, we examine the clinical, biochemical, and liver histopathologic characteristics of possible CAM‐DILI‐related ACLF, describe implicated CAM agents, and discuss predictors of patient outcomes. Out of 1,666 patients with cirrhosis, 68% used CAM at some point. A total of 35.7% (n = 30/84) patients presented with CAM‐related DILI leading to ACLF in the whole CAM‐DILI‐related decompensation cohort. The most common CAM was unlabeled polyherbal Ayurvedic formulations. Of possible patients with ACLF, 63% self‐medicated with CAM based on social media sharing. Mean age ± SD was 51.9 ± 9.9 years, 83% were male patients, median follow‐up duration was 173 (range, 14‐584) days, median Child‐Turcotte‐Pugh score was 13 (range, 10‐14), Model for End‐Stage Liver Disease‐sodium score was 30.1 ± 4.8, median chronic liver failure‐organ failure (CLIF‐C‐OF) score was 11 (range, 8‐14), and median CLIF‐C‐ACLF score was 98 (range, 87‐127). Portal‐based neutrophilic predominant mixed inflammation, hepatocyte ballooning, autoimmune‐like features, and severe cholestasis were seen on liver biopsy. Overall, 53% of patients died (median survival 194 days). Baseline overt hepatic encephalopathy and CLIF‐C‐OF score, total bilirubin, hyponatremia and leukocytosis, and grade of ACLF predicted 1‐, 3‐, 6‐ and 12‐month mortality, respectively. Conclusion: Possible CAM‐DILI‐related ACLF has a high mortality. Strict monitoring and identification of CAM use among people with cirrhosis and an integrative public health educational practice can help ameliorate this modifiable risk factor that potentiates heavy liver disease burden and resource use.
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In some cohorts, DILI in patients with underlying liver disease has been associated with mortality rates as high as 16%, compared to ~5% in patients without pre-existing liver disease.
“In some cohorts, DILI in patients with underlying liver disease has been associated with mortality rates as high as 16%, compared to ~5% in patients without pre-existing liver disease.8,27,28”
From Ashwagandha-induced liver injury—A case series from India and literature review (2023) · cites this paper as [8]
The Results (Outcomes and Significant Predictors; page unavailable) report mortality among patients with cirrhosis and possible CAM-related DILI, supporting the general point that DILI can be associated with death in patients with underlying liver disease. The paper reports 53% mortality in that cohort, however, and does not provide the claimed 16% versus approximately 5% comparison with patients without pre-existing liver disease. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAyurvedic herbal supplements have been implicated in serious liver injury, acute decompensation of cirrhosis, and acute-on-chronic liver failure.
“Ayurvedic herbal supplements have been implicated in serious liver injury, acute decompensation of cirrhosis, and acute-on-chronic liver failure.7–9”
From Ashwagandha-induced liver injury—A case series from India and literature review (2023) · cites this paper as [8]
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Drug-induced liver injury: Asia Pacific Association of Study of Liver consensus guidelines
Devarbhavi, H., Aithal, G., Treeprasertsuk, S., Takikawa, H., Mao, Y., Shasthry, S. M., Hamid, S., Tan, S. S., Philips, C. A., George, J., et al. (2021) · Hepatology International · doi:10.1007/s12072-021-10144-3 · Cited by 181
Self-citationAshwagandha-induced liver injury—A case series from India and literature review
Philips, C. A., Valsan, A., Theruvath, A. H., Ravindran, R., Oommen, T. T., Rajesh, S., Bishnu, S., Augustine, P., & India, O. B. O. T. L. R. C. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000270 · Cited by 62
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Metadata
- Authors
- Philips, C. A., Paramaguru, R., Augustine, P., Rajesh, S., Ahamed, R., George, T., & Padsalgi, G.
- Affiliations
- General Hospital Ernakulam (IN)
- PVS Memorial Hospital (IN)
- Corresponding author
- Philips, Cyriac Abby
- Venue
- Hepatology Communications
- Published
- 2019-04-12
- Volume
- 3
- Issue
- 7
- Pages
- 1001-1012
- ISSN
- 2471-254X (ISSN-L)
- PMC
- PMC6601323
- OpenAlex
- W2939861386
- Cited by
- 32
- References
- 0
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 5 · 2023: 4 · 2022: 6 · 2021: 4 · 2020: 2 · 2019: 2
- FWCI
- 4.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Hepatology Communications (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- complementary and alternative medicine, drug-induced liver injury, acute-on-chronic liver failure, liver cirrhosis, Ayurvedic polyherbal formulation, self-medication, social media health information, mortality risk factors, hepatic encephalopathy, CLIF-C ACLF score, liver histopathology, hepatocyte ballooning, cholestasis, hepatotoxicity
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