Title:Gynura Segetum Related Hepatic Sinusoidal Obstruction Syndrome: A Liver Disease with High Mortality and Misdiagnosis Rate
Volume: 25
Issue: 35
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*Jun Chen*
Affiliation:
- Liver Diseases Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011,China
- Department of Liver Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, 518100,China
Keywords:
Gynura segetum, hepatic sinusoidal obstruction syndrome (HSOS), Chinese herbal medicine, DILI, hepatomegaly, splenomegaly.
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.
