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Clinical outcomes associated with complementary and alternative medicine-related “immunity-boosting” practices in patients with cirrhosis during the COVID-19 pandemic – an observational study
Open accessAbstract
During the coronavirus disease 2019 pandemic, Ayurvedic herbal supplements and homeopathic immune boosters (IBs) were promoted as disease-preventive agents. The present study examined the clinical outcomes among patients with chronic liver disease who presented with complications of portal hypertension or liver dysfunction temporally associated with the use of IBs in the absence of other competing causes. This single-center retrospective observational cohort study included patients with chronic liver disease admitted for the evaluation and management of jaundice, ascites, or hepatic encephalopathy temporally associated with the consumption of IBs and followed up for 180 days. Chemical analysis was performed on the retrieved IBs. From April 2020 to May 2021, 1022 patients with cirrhosis were screened, and 178 (19.8%) were found to have consumed complementary and alternative medicines. Nineteen patients with cirrhosis (10.7%), jaundice, ascites, hepatic encephalopathy, or their combination related to IBs use were included. The patients were predominantly male (89.5%). At admission, 14 (73.75%) patients had jaundice, 9 (47.4%) had ascites, 2 (10.5%) presented with acute kidney injury, and 1 (5.3%) had overt encephalopathy. Eight patients (42.1%) died at the end of the follow up period. Hepatic necrosis and portal-based neutrophilic inflammation were the predominant features of liver biopsies. IB analysis revealed detectable levels of (heavy metals) As (40%), Pb (60%), Hg (60%), and various hepatotoxic phytochemicals. Ayurvedic and Homeopathic supplements sold as IBs potentially cause the worsening of preexisting liver disease. Responsible dissemination of scientifically validated, evidence-based medical health information from regulatory bodies and media may help ameliorate this modifiable liver health burden.
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“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 [9]
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“and drug-triggered autoimmune hepatitis is not uncommon, especially in the context of HILI.7,9,17,31”
From Ashwagandha-induced liver injury—A case series from India and literature review (2023) · cites this paper as [9]
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“and are very commonly described in patients with DILI”
From Ashwagandha-induced liver injury—A case series from India and literature review (2023) · cites this paper as [9]
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“Mild elevations of autoimmune markers are not pathognomonic for autoimmune hepatitis”
From Ashwagandha-induced liver injury—A case series from India and literature review (2023) · cites this paper as [9]
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Cites
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
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Cited by
Sorted by citations
Ashwagandha-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
Self-citation
Metadata
- Authors
- Philips, C. A., Theruvath, A. H., Raveendran, R., Ahamed, R., Rajesh, S., Abduljaleel, J. K., Tharakan, A., & Augustine, P.
- Affiliations
- Rajagiri Hospital (IN)
- Corresponding author
- Philips, Cyriac Abby
- ORCID
- Venue
- Medicine
- Published
- 2023-03-24
- Volume
- 102
- Issue
- 12
- Pages
- e33365
- ISSN
- 0025-7974 (ISSN-L)
- PMC
- PMC10035553
- OpenAlex
- W4360803886
- Cited by
- 5
- References
- 2
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 2
- FWCI
- 1.42
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- 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, liver cirrhosis, chronic liver disease, COVID-19 pandemic, jaundice, ascites, hepatic encephalopathy, hepatotoxicity, heavy metals, portal hypertension complications
- MeSH terms
- COVID-19, Complementary Therapies, Ascites, Female, Hepatic Encephalopathy, Humans, Jaundice, Liver Cirrhosis, Male, Retrospective Studies, Pandemics
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