Clinicopathological features of Bu Gu Zhi‐induced liver injury, a long‐term follow‐up cohort study. (22nd December 2019)

• Record Type: Journal Article
• Authors: Wang, Lan; Wang, Yan; Wee, Aileen; Soon, Gwyneth; Gouw, Annette S. H.; Yang, Ruiyuan; Tian, Qiuju; Liu, Liwei; Ma, Hong; Zhao, Xinyan
• Is Part Of: Liver international. Volume 40:Number 3(2020)
• Page Start: 571
• Page End: 580
• Publication Date: 2019-12-22
• Subjects: Bu Gu Zhi -- clinical and pathological features -- liver injury -- Psoralea corylifolia Linn; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.14306
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: Background & Aims: Bu Gu Zhi (BGZ) is a Chinese herb consumed mainly for osteoporosis treatment. Only small case series of BGZ‐induced liver injury (BGZILI) have been reported. We describe the clinicopathological features and clinical course of BGZILI. Methods: Patients diagnosed with drug‐induced liver injury (DILI) at Beijing Friendship Hospital from 2005 to 2017 were reviewed. Clinical and follow‐up data were analysed. Results: Of the 547 DILI patients, 40 cases (7.3%) were attributed to BGZILI. About 34/40 (85.0%) patients were females with a median age of 63 (range, 54‐70) years. The median latency period was 45 (range, 29‐90) days. Patients commonly presented with loss of appetite (57.5%), dark urine (57.5%) and fatigue (55.0%). The median level of alanine aminotransferase and aspartate aminotransferase at BGZILI onset was 673.5 and 423.0 U/L respectively. Total bilirubin (TB) and direct bilirubin (DB) were 59.0 and 39.4 µmol/L respectively. The biochemical liver injury pattern was hepatocellular (92.5%), cholestatic (5.0%) and mixed (2.5%). They were categorized into 'mild' (N = 23, 57.5%), 'moderate' (6, 15.0%) or 'severe' (11, 27.5%) according to severity assessment by DILI network. The main histological injury pattern in 9/40 patients with liver biopsy was acute hepatitis with/without cholestasis. Median duration of follow‐up was 26.3 months with recovery in 37 patients within 6 months. No patients died or required transplantation. Conclusions: BGZ‐induced liver injury manifested more often as a hepatocellular injury pattern with mild to moderate hepatocellular damage. Most patients recovered after cessation of BGZ within 6 months, and none developed end‐stage liver disease or died.