S2465 Herbal Supplement-Induced Liver Injury: A Systematic Review of Clinical Characteristics and Outcomes

Introduction: The use of herbal supplements has increased globally, leading to rising reports of adverse health effects, including hepatotoxicity. However, comprehensive data summarizing the clinical characteristics and outcomes of supplement-induced liver injury are limited. Methods: Five different databases, including PubMed, Embase, and Web of Science, were searched up to December 17, 2024. We included all studies that reported liver injury associated with herbal supplement use. The data was extracted using a uniform Excel extraction sheet. All statistical tests were conducted with a 95% confidence interval and a 5% margin of error. A P-value of less than 0.05 was considered statistically significant. Results: A total of 293 cases of herbal supplement-induced liver injury were identified from published reports. The most common study design was case-control (57.7%), followed by case reports (14.7%), case series (13.3%), observational studies (9.9%), and letters (2.7%). Khat was the most frequently implicated supplement (202 cases, 69.0%), followed by turmeric/curcuma (61 cases, 20.8%) and ashwagandha (23 cases, 7.8%). Other supplements, including rooibos tea and Yogi herbal tea, accounted for a small minority of cases. Of the patients described, 152 (51.9%) were woman, 136 (46.4%) were man, and the gender was unspecified in 5 cases (1.7%). The most commonly reported symptoms were jaundice (36 cases, 12.3%), abdominal discomfort or pain (17 cases, 5.8%), and pruritus (16 cases, 5.5%). Discontinuation of the offending supplement was reported as a management strategy in 23 cases (7.8%). Corticosteroid therapy was used in 11 cases (3.8%), and supportive therapy (such as N-acetylcysteine or ursodeoxycholic acid) in 12 cases (4.1%). Most patients (261 cases, 89.1%) recovered fully, while mortality was reported in 9 cases (3.1%). The outcome was unknown in 23 cases (7.9%). Conclusion: Herbal supplements such as khat, turmeric/curcuma, and ashwagandha can cause liver injury, typically presenting with jaundice and abdominal discomfort. Most patients recover, but severe cases do occur. Greater awareness and better reporting are needed to ensure safe use.