studies

318A AASLD ABSTRACTS HEPATOLOGY, October, 2015
211
Clinical Features and Outcomes of Complementary and
Alternative Therapy Medicine (CAM)-Induced Acute Liver
Failure and Injury
Luke Hillman 1 , Daniel Ganger 1 , Michelle Gottfried 2 , Jorge Rakela 3 ,
Michael L. Schilsky 4 , William M. Lee 5 ; 1 Medicine, Northwestern
University, Chicago, IL; 2 MUSC, Charleston, SC; 3 Medicine, Mayo
Clinic, Scottdsdale, AZ; 4 Medicine and Surgery, Yale University,
New Haven, CT; 5 Internal Medicine, University of Texas Southwestern,
Dallas, TX
Background: Increased use of CAM across the United States
is evidenced by increased expenditures and reported use by
consumers. While idiosyncratic drug-induced liver injury (DILI)
from conventional prescription medicines is often severe, DILI
from CAM is similarly infrequent but causes significant hepatotoxicity.
AIM: We examined clinical features and outcomes
among patients with acute liver failure (ALF) and acute liver
injury (ALI) enrolled in the Acute Liver Failure Study Group
(ALFSG) database, comparing conventional DILI injury to that
due to CAMs. Patients and Methods: ALFSG has prospectively
enrolled 2626 subjects with ALF/ALI since 1998 from U.S.
academic liver transplant centers through January 8, 2015.
We compared clinical presentation, course and outcome
between those with ALF/ALI due to ‘conventional’ DILI versus
CAMs. Results: We found 251 (10.4%) subjects deemed by
DILIN criteria to have DILI-ALF, 210 (83.7%) due to conventional
medicines and 41 (16.3%) from CAM, with a higher %
of DILI cases due to CAM between 2008-2015, as compared
to 1998-2007 (18.1% vs. 12.4%, p = 0.047). There was no
difference in the type of liver injury (hepatocellular, cholestatic,
or mixed injury) between groups as determined by R score
(p=0.26). On day 1 of enrollment, conventional medicine DILI
showed higher serum alkaline phosphatase levels compared
to the CAM group (mean IU/L, 215.1 vs. 156.2, p=0.005);
there were no differences between both cohorts in ALT/AST,
INR, platelets, bilirubin or MELD score or coma grade. Despite
fewer individual comorbidities were noted in the CAM population
(2.03 vs. 1.15, p=0.005), the CAM group had a lower
transplant-free survival at 21 days, though this was not statistically
significant (24.3% vs. 38.5%, p=0.10). Within the CAM
group, those surviving without transplantation had significantly
lower INRs (1.9 vs. 3.8, p