Prognostic factors for pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome: a multicenter study in China

Abstract

Background: In China, one of the major causes of hepatic sinusoidal obstruction syndrome (HSOS) is the intake of herbals containing pyrrolizidine alkaloid (PA). However, prognostic factors for PA-induced HSOS are poorly understood. The aim of this study was to identify the independent prognostic factors for PAinduced HSOS using a multi-center study. Methods: A total of 117 PA-induced HSOS patients were enrolled for data collection in three university hospitals from November 2003 to September 2018. Univariate and multivariate Cox proportional hazards analysis were used to determine prognostic factors for PA-induced HSOS. Results: The median age of the PA-induced HSOS patients was 61 years (range, 21-88 years), and 64% of them were male. The survival rates at 1, 3, and 36 months were 89.71%, 72.60%, and 69.19%, respectively. Significant differences in prothrombin time (PT), international normalized ratio, total bilirubin, severity grading [new criteria for severity grading of hematopoietic stem cell transplantation (HSCT)-related HSOS in adults] were found between patients who survived and those who died. Univariate and multivariate survival analysis using Cox's regression model demonstrated low serum albumin (<35 g/L), elevated serum urea (>8.2 mmol/L) and severe or very severe HSOS (European Society for Blood and Marrow Transplantation 2016 criteria) were independent prognostic factors of survival. Conclusions: Serum albumin, serum urea, and severity grading were independent prognostic factors for patients with PA-induced HSOS, and can contribute to identifying potentially high-risk patients for early effective intervention. Trial registration: ChiCTR-DRD-17010709 (www.chictr.org.cn).

Enoxaparin attenuates pyrrolizidine alkaloids‐induced hepatic sinusoidal obstruction syndrome by inhibiting oncostatin M expression

“…Of 91 patients, 80 patients (87.91%) received symptomatic therapy containing the termination of PAs exposure, symptomatic treatment, hepatoprotective drugs (symptomatic group) and 11 patients (12.09%) received anticoagulation therapy containing LMWH plus symptomatic therapy (LMWH group). Our study and previous studies demonstrated a cumulative survival rate of 6, 12 and 36 months were similar in patients with PAs‐induced HSOS 10,11,14 ; thus, survival patients with a minimum follow‐up period of 1 year were enrolled in our study. Table 1 summarized relevant demographic and clinical biochemistry at the time of baseline evaluation.…”

“…The intake of PAs-containing medicinal herbs is one of the major etiologies of HSOS. 3,8,10,14,[21][22][23][24][25] Definitive treatment for PAs-induced HSOS is not available in clinical practice. 3,4 Our study demonstrated enoxaparin, an anticoagulant, improved the prognosis of patients with PAs-induced HSOS.…”

“…PAs-induced HSOS 10,11,14 ; thus, survival patients with a minimum follow-up period of 1 year were enrolled in our study. Table 1 summarized relevant demographic and clinical biochemistry at the time of baseline evaluation.…”

Mid- to long-term outcomes of initial transjugular intrahepatic portosystemic shunt versus anticoagulation for pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome

“…The present findings indicate that initial TIPS may provide a greater survival benefit than AT for the management of severe or very severe PA-induced HSOS. Moreover, Shang et al [25] demonstrated that the presence of severe or very severe disease is an independent prognostic factor in patients with PA-induced HSOS and is associated with a higher mortality rate than that of mild or moderate disease. In the present study, all the patients with very severe HSOS and 40% of those with severe HSOS died in the AT group, whereas all the patients survived in the TIPS group.…”

The value of hepatic venous pressure gradient in patients with pyrrolidine alkaloid-induced hepatic sinusoidal obstruction syndrome

“…In 2017, the rst diagnostic criteria and treatment strategy for PA-HSOS were proposed 7 . Anticoagulation-transjugular intrahepatic portosystemic shunt (TIPS) stepwise therapy (anticoagulation rst, if no response, step-up to TIPS therapy) is recommended, and this has an increased survival up to 91% 1,[8][9][10][11][12] . However, the exact mechanism of this treatment modality is unclear.…”