Herb-induced Liver Injury: An Updated Meta-analysis and Bibliometric Analysis

The global rise of herbal medicine as an alternative treatment has led to an increase in herb-induced liver injury (HILI). To examine this link and its clinical relevance, our meta-analysis and bibliometric analysis reviewed HILI cases reported in English literature. Our analysis identified 389 studies with 654 patients. We found a global increase in HILI reports, particularly between 2002 and 2011. Weight management was the most common reason for herbal use. Shou-Wu-Pian, Germander, Tinospora spp., Greater Celandine, and Mahuang were frequently implicated. Additionally, mixed herbal products consumption involved a higher risk of transplantation or death and shorter latency periods than single herbs. Females, accounting for 65.2% of cases, were often older at onset and with longer herb use, while males had a higher chance of having high Gamma Glutamyl Transferase (GGT) levels. Older age correlated with less severe injury but higher GGT, longer herb use, and latency. Race influenced International Normalized Ratio INR), Total bilirubin (TBL), and injury severity. Our study provides valuable insights for healthcare practitioners. Considering factors like gender, age, race, and usage patterns is essential for diagnosing and managing HILI.