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Predictors of poor outcomes in 488 patients with herb-induced liver injury

Zhu, Yun, Niu, Ming, Wang, Jia-Bo, Wang, Rui-Lin, Li, Jian-Yu, Ma, Yan-Qi, Zhao, Yan-Ling, Zhang, Yan-Fang, He, Ting-Ting, Yu, Si-Miao, Guo, Yu-Ming, Zhang, Fan, Xiao, Xiao-He, Schulze, Johannes·2019·Turkish Journal of Gastroenterology
DOI 10.5152/tjg.2018.17847
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Abstract

Background/Aims: Herb-induced liver injury (HILI) can lead to chronic liver injury, liver transplantation, or even death. This study aimed to identify the predictors of poor HILI outcomes, especially chronic HILI. Materials and Methods: Clinical data of 488 patients with HILI were retrospectively analyzed from a Chinese center between January 2010 and January 2014. Logistic regression and C-statistic were used to identify risk factors and prognostic models for HILI outcomes. Results: In all patients, 69 (14.1%) developed chronic HILI, and 20 (4.1%) died due to liver injury or underwent liver transplantation. To predict the fatal HILI prognosis, the model for end-stage liver disease (MELD) with a C-statistic of 0.981 (95%CI 0.968-0.995) was better than Hy’s law (C-statistic 0.569; 95%CI 0.449-0.689). The latency, course of peak alanine aminotransferase decreasing ≥50% after discontinuation of herb application, peak triglyceride value, and platelet count at liver injury onset were identified as independent risk factors for chronicity with the adjusted odds ratios of 1.268 (95% confidence interval [CI] 1.034-1.554), 2.303 (95%CI 1.588-3.340), 0.580 (95%CI 0.343-0.978), and 0.183 (95%CI 0.091-0.368), respectively. A prognostic model for chronic HILI based on these four factors yielded the best prediction with a C-statistic of 0.812 (95%CI 0.755-0.868), compared with MELD (C-statistic 0.506; 95%CI 0.431-0.581) and Hy’s law (C-statistic 0.418; 95%CI 0.343-0.492). Conclusion: Model for end-stage liver disease can be used to predict the fatal prognosis of HILI. A long latency, slow recovery, and low triglyceride value and platelet counts are important determinants for chronic HILI. Cite this article as: Zhu Y, Niu M, Wang JB, et al. Predictors of poor outcomes in 488 patients with herb-induced liver injury. Turk J Gastroenterol 2019; 30: 47-58.

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Figure 1 The diagnosis and prognosis of patients with HILI HILI: Herb-induced liver injury
Figure 1 The diagnosis and prognosis of patients with HILI HILI: Herb-induced liver injuryCC-BY-NC · From the PDF
Figure 2 Receiver operating characteristic (ROC) curves to predict the fatal prognosis of HILI: MELD (C-statistic 0.981; 95% CI 0.968-0.995) and Hy's law (C-statistic 0.569; 95% CI 0.449-0.689)
Figure 2 Receiver operating characteristic (ROC) curves to predict the fatal prognosis of HILI: MELD (C-statistic 0.981; 95% CI 0.968-0.995) and Hy's law (C-statistic 0.569; 95% CI 0.449-0.689)CC-BY-NC · From the PDF
Figure 3 Receiver operating characteristic (ROC) curves to predict the chronic prognosis of HILI: the model for chronic HILI (C-statistic 0.812; 95%CI 0.755-0.868), MELD (C-statistics 0.506; 95%CI 0.4310.581), and Hy's law (C-statistics 0.418; 95%CI 0.343-0.492)
Figure 3 Receiver operating characteristic (ROC) curves to predict the chronic prognosis of HILI: the model for chronic HILI (C-statistic 0.812; 95%CI 0.755-0.868), MELD (C-statistics 0.506; 95%CI 0.4310.581), and Hy's law (C-statistics 0.418; 95%CI 0.343-0.492)CC-BY-NC · From the PDF

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Research works printed but not linked: 27

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Metadata

Authors
Zhu, Y., Niu, M., Wang, J.-B., Wang, R.-L., Li, J.-Y., Ma, Y.-Q., Zhao, Y.-L., Zhang, Y.-F., He, T.-T., Yu, S.-M., Guo, Y.-M., Zhang, F., Xiao, X.-H., & Schulze, J.
Venue
Turkish Journal of Gastroenterology
Publisher
AVES YAYINCILIK A.Ş.
Published
2019-07-25
Volume
30
Issue
1
Pages
47-58
ISSN
2148-5607
DOI
10.5152/tjg.2018.17847
Cited by
5
References
0
Licence
creativecommons.org/licenses/by-nc/4.0 (unspecified)

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