{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T17:04:40Z","timestamp":1773248680589,"version":"3.50.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2019,4,12]],"date-time":"2019-04-12T00:00:00Z","timestamp":1555027200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:p>Drug\u2010induced liver injury (DILI) due to complementary and alternative medicine (CAM) use is on the rise throughout the world by patients looking for \u201csafer\u201d alternatives. However, data on acute\u2010on\u2010chronic liver failure (ACLF) due to CAM are lacking. In a large cohort of patients with cirrhosis, we retrospectively studied CAM\u2010related health\u2010seeking behavior and attempted to identify those who developed possible CAM\u2010DILI\u2010related ACLF. In this study, we examine the clinical, biochemical, and liver histopathologic characteristics of possible CAM\u2010DILI\u2010related ACLF, describe implicated CAM agents, and discuss predictors of patient outcomes. Out of 1,666 patients with cirrhosis, 68% used CAM at some point. A total of 35.7% (n = 30\/84) patients presented with CAM\u2010related DILI leading to ACLF in the whole CAM\u2010DILI\u2010related decompensation cohort. The most common CAM was unlabeled polyherbal Ayurvedic formulations. Of possible patients with ACLF, 63% self\u2010medicated with CAM based on social media sharing. Mean age \u00b1 SD was 51.9 \u00b1 9.9 years, 83% were male patients, median follow\u2010up duration was 173 (range, 14\u2010584) days, median Child\u2010Turcotte\u2010Pugh score was 13 (range, 10\u201014), Model for End\u2010Stage Liver Disease\u2010sodium score was 30.1 \u00b1 4.8, median chronic liver failure\u2010organ failure (CLIF\u2010C\u2010OF) score was 11 (range, 8\u201014), and median CLIF\u2010C\u2010ACLF score was 98 (range, 87\u2010127). Portal\u2010based neutrophilic predominant mixed inflammation, hepatocyte ballooning, autoimmune\u2010like features, and severe cholestasis were seen on liver biopsy. Overall, 53% of patients died (median survival 194 days). Baseline overt hepatic encephalopathy and CLIF\u2010C\u2010OF score, total bilirubin, hyponatremia and leukocytosis, and grade of ACLF predicted 1\u2010, 3\u2010, 6\u2010 and 12\u2010month mortality, respectively. <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>: Possible CAM\u2010DILI\u2010related ACLF has a high mortality. Strict monitoring and identification of CAM use among people with cirrhosis and an integrative public health educational practice can help ameliorate this modifiable risk factor that potentiates heavy liver disease burden and resource use.<\/jats:p>","DOI":"10.1002\/hep4.1355","type":"journal-article","created":{"date-parts":[[2019,4,12]],"date-time":"2019-04-12T14:22:36Z","timestamp":1555078956000},"page":"1001-1012","source":"Crossref","is-referenced-by-count":30,"title":["A Single\u2010Center Experience on Outcomes of Complementary and Alternative Medicine Use Among Patients With Cirrhosis"],"prefix":"10.1097","volume":"3","author":[{"given":"Cyriac Abby","family":"Philips","sequence":"first","affiliation":[{"name":"Liver Unit, Cochin Gastroenterology Group,Ernakulam Medical Center Hospital,Kochi,India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajaguru","family":"Paramaguru","sequence":"additional","affiliation":[{"name":"Pathology,PVS Memorial Hospital,Kochi,India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Augustine","sequence":"additional","affiliation":[{"name":"Gastroenterology,Ernakulam Medical Center Hospital,Kochi,India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sasidharan","family":"Rajesh","sequence":"additional","affiliation":[{"name":"Interventional Radiology, Cochin Gastroenterology Group,Ernakulam Medical Center Hospital,Kochi,India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rizwan","family":"Ahamed","sequence":"additional","affiliation":[{"name":"Gastroenterology,Ernakulam Medical Center Hospital,Kochi,India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"George","sequence":"additional","affiliation":[{"name":"Interventional Radiology, Cochin Gastroenterology Group,Ernakulam Medical Center Hospital,Kochi,India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guruprasad","family":"Padsalgi","sequence":"additional","affiliation":[{"name":"Gastroenterology,Ernakulam Medical Center Hospital,Kochi,India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2019,4,12]]},"reference":[{"key":"hep41355-bib-0001-20240114","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s41256-017-0026-y","article-title":"Examining the changing health care seeking behavior in the era of health sector reforms in India: evidences from the National Sample Surveys 2004 & 2014","volume":"2","year":"2017","journal-title":"Glob Health Res Policy"},{"key":"hep41355-bib-0002-20240114","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.socscimed.2013.02.018","article-title":"Which doctor for primary health care? 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