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Current Pharmaceutical Design

Editor-in-Chief

ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

General Research Article

Gynura Segetum Related Hepatic Sinusoidal Obstruction Syndrome: A Liver Disease with High Mortality and Misdiagnosis Rate

Author(s): Pengcheng Ou, Xinyu Liu, Zhiqun Tang, Zhouhua Hou, Li Liu, Jun Liu, Shangchen Zhou, Zhixiong Fang, Kewei Sun, Yue Chen, Xiaobei Chen, Yi Li* and Jun Chen*

Volume 25, Issue 35, 2019

Page: [3762 - 3768] Pages: 7

DOI: 10.2174/1381612825666191007162024

Price: $65

Abstract

Background and Aim: Gynura segetum (Tusanqi or Jusanqi) is widely used in China as a herbal remedy, however, it has often been associated with hepatic sinusoidal obstruction syndrome (HSOS). Its extent in inducing hepatotoxicity is not sufficiently understood. Hence, we aimed to identify the characteristic features of Gynura segetum associated HSOS.

Methods: A total of 64 patients diagnosed with HSOS induced by gynura segetum were enrolled from eight Chinese tertiary care hospitals between 2008 and 2018. General information regarding diagnosis, disease history, suspected drug use, symptoms and signs, biochemical index, imaging data, liver histology, treatment methods, severity and prognosis were collected and analyzed.

Results: The mean age of the enrolled patients were 58.07±11.44 years. Male patients accounted for 64.1% of HSOS patients. The median latency period was 75 days. The number of patients with a definite diagnosis from the eight hospitals was 5 (7.81%), with a misdiagnosis rate of 92.18%. Hepatomegaly, splenomegaly, ascites and lower limbs edema were present in 89.1%, 76.6%, 81.3% and 43.8% of the patients, respectively. The imaging characteristic changes were liver parenchyma echo thickening, uneven density, and hepatic vein stenosis and occlusion. Liver biopsies had characteristic pathological changes. Except for ALT and D-Dimer, liver function and coagulation index at admission and before discharge were not significantly different (p>0.05). The 6-month mortality rate was 77.55%, with upper-gastrointestinal bleeding being the leading cause of death (42.11%). The second leading cause of death was a secondary infection (36.84%), while the third was hepatorenal syndrome (21.05%).

Conclusion: Gynura segetum related HSOS often presents as progressive hepatic congestion, portal hypertension and liver failure, and has a high mortality and misdiagnosis rate.

Keywords: Gynura segetum, hepatic sinusoidal obstruction syndrome (HSOS), Chinese herbal medicine, DILI, hepatomegaly, splenomegaly.

[1]
Lin G, Wang JY, Li N, et al. Hepatic sinusoidal obstruction syndrome associated with consumption of Gynura segetum. J Hepatol 2011; 54(4): 666-73.
[http://dx.doi.org/10.1016/j.jhep.2010.07.031] [PMID: 21146894]
[2]
Valla DC, Cazals-Hatem D. Sinusoidal obstruction syndrome. Clin Res Hepatol Gastroenterol 2016; 40(4): 378-85.
[http://dx.doi.org/10.1016/j.clinre.2016.01.006] [PMID: 27038846]
[3]
Dignan FL, Wynn RF, Hadzic N, et al. BCSH/BSBMT guideline: diagnosis and management of veno-occlusive disease (sinusoidal obstruction syndrome) following haematopoietic stem cell transplantation. Br J Haematol 2013; 163(4): 444-57.
[http://dx.doi.org/10.1111/bjh.12558] [PMID: 24102514]
[4]
Mohty M, Malard F, Abecassis M, et al. Sinusoidal obstruction syndrome/veno-occlusive disease: current situation and perspectives-a position statement from the european society for blood and marrow transplantation (EBMT). Bone Marrow Transplant 2015; 50(6): 781-9.
[http://dx.doi.org/10.1038/bmt.2015.52] [PMID: 25798682]
[5]
Shulman HM, Hinterberger W. Hepatic veno-occlusive disease-liver toxicity syndrome after bone marrow transplantation. Bone Marrow Transplant 1992; 10(3): 197-214.
[PMID: 1422475]
[6]
Jones RJ, Lee KS, Beschorner WE, et al. Venoocclusive disease of the liver following bone marrow transplantation. Transplant 1987; 44(6): 778-83.
[http://dx.doi.org/10.1097/00007890-198712000-00011] [PMID: 3321587]
[7]
Dai N, Yu YC, Ren TH, et al. Gynura root induces hepatic veno-occlusive disease: a case report and review of the literature. World J Gastroenterol 2007; 13(10): 1628-31.
[http://dx.doi.org/10.3748/wjg.v13.i10.1628] [PMID: 17461462]
[8]
Sun Z, Kang J, Zhang Y. Hepatic veno-occlusive disease related to Gynura segetum: a case report. Medicine (Baltimore) 2018; 97(17)e0552
[http://dx.doi.org/10.1097/MD.0000000000010552] [PMID: 29703039]
[9]
Gao H, Li N, Wang JY, Zhang SC, Lin G. Definitive diagnosis of hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloids. J Dig Dis 2012; 13(1): 33-9.
[http://dx.doi.org/10.1111/j.1751-2980.2011.00552.x] [PMID: 22188914]
[10]
Yang S, Wu J, Lei S. CT features of hepatic veno-occlusive disease: a meta-analysis. Acad Radiol 2018; 25(3): 328-37.
[http://dx.doi.org/10.1016/j.acra.2017.10.012] [PMID: 29191686]
[11]
Zhou H, Wang YX, Lou HY, Xu XJ, Zhang MM. Hepatic sinusoidal obstruction syndrome caused by herbal medicine: CT and MRI features. Korean J Radiol 2014; 15(2): 218-25.
[http://dx.doi.org/10.3348/kjr.2014.15.2.218] [PMID: 24643319]
[12]
Chojkier M. Hepatic sinusoidal-obstruction syndrome: toxicity of pyrrolizidine alkaloids. J Hepatol 2003; 39(3): 437-46.
[http://dx.doi.org/10.1016/S0168-8278(03)00231-9] [PMID: 12927933]
[13]
Coppell JA, Richardson PG, Soiffer R, et al. Hepatic veno-occlusive disease following stem cell transplantation: incidence, clinical course, and outcome. Biol Blood Marrow Transplant 2010; 16(2): 157-68.
[http://dx.doi.org/10.1016/j.bbmt.2009.08.024] [PMID: 19766729]
[14]
Zhuge Y, Liu Y, Xie W, Zou X, Xu J, Wang J. Chinese society of gastroenterology committee of hepatobiliary disease. Expert consensus on the clinical management of pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome. J Gastroenterol Hepatol 2019; 34(4): 634-42.
[http://dx.doi.org/10.1111/jgh.14612] [PMID: 30669184]
[15]
Mohty M, Malard F, Abecassis M, et al. Revised diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in adult patients: a new classification from the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2016; 51(7): 906-12.
[http://dx.doi.org/10.1038/bmt.2016.130] [PMID: 27183098]
[16]
Wang Y, Qiao D, Li Y, et al. Risk factors for hepatic veno-occlusive disease caused by Gynura segetum: a retrospective study. BMC Gastroenterol 2018; 26(18): 1-156.
[http://dx.doi.org/10.1186/s12876-018-0879-7]
[17]
Weitz JI, Fredenburgh JC, Eikelboom JW. A test in context: D-Dimer. J Am Coll Cardiol 2017; 70(19): 2411-20.
[http://dx.doi.org/10.1016/j.jacc.2017.09.024] [PMID: 29096812]
[18]
Nassereddine S, Alsubait S, Tabbara I. Sinusoidal obstruction syndrome (veno-occlusive disease) following hematopoietic stem cell transplant: insights and therapeutic advances. Anticancer Res 2018; 38(5): 2597-605.
[19]
Cheuk DK, Chiang AK, Ha SY, Chan GC. Interventions for prophylaxis of hepatic veno-occlusive disease in people undergoing haematopoietic stem cell transplantation. Cochrane Database Syst Rev 2015; 27(5)CD009311
[http://dx.doi.org/10.1002/14651858.CD009311.pub2] [PMID: 26017019]
[20]
Wang X, Qi X, Guo X. Tusanqi-related sinusoidal obstruction syndrome in china: a systematic review of the literatures. Medicine (Baltimore) 2015; 94(23)e942
[http://dx.doi.org/10.1097/MD.0000000000000942] [PMID: 26061322]
[21]
Wang JY, Gao H. Tusanqi and hepatic sinusoidal obstruction syndrome. J Dig Dis 2014; 15(3): 105-7.
[http://dx.doi.org/10.1111/1751-2980.12112] [PMID: 24528632]

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