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Herbal and dietary supplement-induced liver injury in Taiwan: comparison with conventional drug-induced liver injury

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Abstract

Background and aims

Whether herbal and dietary supplements (HDS) are safer than Western conventional drugs is controversial. The aim of this study was to explore the characteristics and risk factors for HDS-induced liver injury (HILI) in Taiwan.

Methods

This is a 9-year multi-center prospective study conducted in Taiwan from 2011 to 2019. Patients with HILI were compared to those with conventional drug-induced liver injury (CILI).

Results

A total of 1,297 patients were enrolled, of whom 285 (22.0%) had HILI and 1,012 (78.0%) had CILI. Compared to the CILI group, the HILI group had higher initial serum alanine aminotransferase, alkaline phosphatase (ALP), peak ALP and bilirubin levels, and higher rates of jaundice, ascites, encephalopathy, coagulopathy, sepsis and acute liver failure. In addition, the HILI group had a higher mortality rate than the CILI group (12.6 vs. 8.0%, p = 0.016). Hepatitis B carrier status, elevated baseline liver biochemical tests and the use of crude herbs (without processing) were associated with an increased risk of HILI-related mortality (adjusted hazard ratios [95% confidence intervals]: 2.90 [1.43–5.99], 2.40 [1.01–5.68] and 2.94 [1.45–5.97], respectively).

Conclusions

HDS are popular and incriminated in more than one-fifth of drug-induced liver injuries in Taiwan. The patients with HILI were more severe than those with CILI in terms of liver biochemical tests, complications and mortality. Hepatitis B carriers, those with elevated baseline liver tests and crude herb users may have a higher risk of HILI-related mortality. The prudent use of HDS is suggested in these high-risk subjects.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thanks Yi-Chen Yeh, MD, and Fen-Yau Li, MD, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, for their reading and interpretation of the liver pathology.

Funding

The study was supported by the Grants from Taiwan Food and Drug Administration (TFDA), Ministry of Health and Welfare, Taiwan (DOH100-99TFDA-P-092 and DOH101-FDA-41103), and Taipei Veterans General Hospital, Taiwan (V110C-022).

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, and National Yang Ming Chiao Tung University School of Medicine, 201, Section 2, Shi-Pai Road, Taipei, 11217, Taiwan

    Yi-Shin Huang & Yi-Hsiang Huang

  2. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Ting-Tsung Chang

  3. Department of Internal Medicine, Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan

    Cheng-Yuan Peng

  4. Department of Medical Research, Digestive Center, E-DA Hospital, Kaohsiung, Taiwan

    Gin-Ho Lo

  5. Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Lin-Kou, and Chang Gung University College of Medicine, Lin-Kou, Taiwan

    Chao-Wei Hsu

  6. Division of Gastroenterology and Hepatology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan

    Chi-Tan Hu

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Contributions

YSH: study concept and design, data collection and interpretation, statistical analysis, and drafting manuscript. TTC: study concept and design, data collection and interpretation, and manuscript editing for important intellectual contents. CYP: data collection and interpretation, and manuscript editing for important intellectual contents. GHL: data collection and interpretation, and manuscript editing for important intellectual contents. CWH: data collection and interpretation, and manuscript editing for important intellectual contents. CTH: data collection and interpretation, and manuscript editing for important intellectual contents. YHH: manuscript review for important intellectual contents. All authors were responsible for reading and approving the final manuscript.

Corresponding author

Correspondence to Yi-Shin Huang.

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Conflict of interest

Yi-Shin Huang, Ting-Tsung Chang, Cheng-Yuan Peng, Gin-Ho Lo, Chao-Wei Hsu, Chi-Tan Hu, and Yi-Hsiang Huang declare that they have no conflict of interest.

Animal research (ethics)

The present study is not an animal research.

Consent to participate (ethics)

Our research complies with the guidelines for human studies and has been conducted ethically in accordance with the World Medical Association Declaration of Helsinki. This study was approved by the Institutional Review Board of each participating hospital for all the data collection and analysis.

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Not applicable.

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None.

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Huang, YS., Chang, TT., Peng, CY. et al. Herbal and dietary supplement-induced liver injury in Taiwan: comparison with conventional drug-induced liver injury. Hepatol Int 15, 1456–1465 (2021). https://doi.org/10.1007/s12072-021-10241-3

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  • DOI: https://doi.org/10.1007/s12072-021-10241-3

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