Kava hepatotoxicity: a clinical survey and critical analysis of 26 suspected cases

Abstract

Kava taken as recommended is associated with rare hepatotoxicity, whereas overdose, prolonged treatment, and comedication may carry an increased risk.

Drug and herb induced liver injury: Council for International Organizations of Medical Sciences scale for causality assessment

“…The sum of the individual scores gives a final score that may range from -9 to +14 points, allowing for sufficient discrimination. The final score provides causality levels for the individual synthetic drug or herb as highly probable, probable, possible, unlikely or excluded (Tables 1 and 2) [12,24,[30][31][32] .…”

“…The lower threshold of ALT > 2N will include multiple cases with nonspecific enzyme increases and requires more stringent exclusion of causes unrelated to drug(s) and herb(s) [24] . Also for low threshold N values, the inclusion rate of alternative diagnoses must be higher; false positive fulfilment of a hepatotoxicity definition results in high numbers of misattributed cases due to overdiagnosing and overreporting [8,12,17,24,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] . This phenomenon is illustrated in a recent HILI study where initial ALT values were available in only 8/22 cases (36%), including 3 cases with a range of 50-69 U/L serum activity [36] .…”

“…This limit is in line with the recommendations of NIH LiverTox equalling 1 drink to 10 g ethanol [44,45] . The impact of including alcohol as a risk factor on the overall CIOMS scoring was negligible as only 9/146 patients (6%) of a HILI study cohort were allotted an alcohol related scoring point (Table 5) [12,30,32,[36][37][38][39][46][47][48] . In these 9 patients, CIOMS causality grading was changed in only one case (patient 16) and unchanged in the other 8 cases (patients 2, 13, 14, 17, 20, 21, 22, 32) ( Table 6).…”

“…Age ≥ 55 years was as a risk factor in 44/146 cases (30%) of the analyzed HILI study cohort (Table 5) [12,30,32,[36][37][38][39][46][47][48] . In 35/44 patients, the overall CIOMS causality grading remained unchanged whether or not age as a risk factor was included in the CIOMS scale scoring (Table 6).…”

“…Reviews addressed general aspects of DILI [6,7] or HILI [4,[8][9][10] , whereas other reports focused on various basic features like clinical course, prognosis, alternative causes, case definition and phenotype standardization [5,[11][12][13][14][15][16][17] . They suggest a similar or identical clinical presentation of DILI and HILI, raising the question of whether HILI needs a separate term.…”