Causality imputation between herbal products and HILI: An algorithm evaluation in a systematic review

• Main Authors: Pedro Felipe Soares, Maria Tereza Calchi Fanti Fernandes, Andréia de Santana Souza, Caio Medina Lopes, Darjore Amorim Carvalho dos Santos, Diogo Pereira Rodrigues Oliveira, Marcela Gottschald Pereira, Nilia Maria De Brito Lima Prado, Gecynalda Soares da Silva Gomes, Genário Santos, Junior, Raymundo Paraná
• Format: Article
• Language: English
• Published: Elsevier 2021-11-01
• Series: Annals of Hepatology
• Subjects: Medicinal herbs; Herbal products; HILI; Liver injury; RUCAM
• Online Access: http://www.sciencedirect.com/science/article/pii/S1665268121002386

Algorithms can have several purposes in the clinical practice. There are different scales for causality imputation in DILI (Drug-Induced Liver Injury), but the applicability and validity of these for the HILI (Herb-Induced Liver Injury) evaluation is questionable for some scales. The purpose of the study was to determine the clinical and demographic profile of the patients with HILI, and the main algorithmic scales used in its causality assessment. The methodology was a systematic review of articles in English, Spanish, or Portuguese language, from 1979 to 2019, involving humans, with descriptors related to HILI. Qualitative and quantitative statistical analysis were performed. As a result, from a total of 60 articles, 203 HILI reports were selected: 59.9% were women, similar with other studies, and the average age was 45.8 years. Jaundice was the most frequent symptom and regarding the type of lesion, the hepatocellular was the most frequent. In regard to HILI severity, 3.0% were severe and 7.6% were fatal or required liver transplantation. In 72.3% of the cases, the most used algorithm was RUCAM (Roussel Uclaf Causality Assessment Method). The conclusion of the study is that RUCAM was the most used algorithm for causality assessment in HILI. The patients were predominantly female, jaundice was the main symptom, and HILI is reversible in the majority of cases.