Gynura Segetum Related Hepatic Sinusoidal Obstruction Syndrome: A Liver disease with High Mortality and Misdiagnosis Rate.

BACKGROUND AND AIM: Gynura segetum (Tusanqi or Jusanqi) is widely used in China and often causes hepatic sinusoidal obstruction syndrome (HSOS). However, its extent in inducing hepatotoxicity is not sufficiently understood. Therefore, we aimed to identify the features of the Gynura segetum related HSOS. METHODS: A total of 64 patients diagnosed with HSOS induced by gynura segetum were recruited from eight Chinese tertiary care hospitals between 2008 and 2018. General information regarding diagnosis, disease history, suspected drug use, symptoms and signs, biochemical index, imaging data, liver histology, treatment methods, severity and prognosis were collected and analyzed. RESULTS: The mean age of the patients was 58.07±11.44 years. Male patients accounted for 64.1% of the HSOS patients. The median latency period was 75 days. The number of patients with definite diagnosis from the eight hospitals was 5 (7.81%), with a misdiagnosis rate of 92.18%. Hepatomegaly, splenomegaly, ascites and lower limbs edema were present in 89.1%, 76.6%, 81.3% and 43.8% of the patients, respectively. The imaging characteristic changes were liver parenchyma echo thickening, uneven density, and hepatic vein stenosis and occlusion. Liver biopsies presented characteristic pathological changes. Except for ALT and D-Dimer, liver function and coagulation index at admission and before discharge had no significant difference (p>0.05). The general 6-month mortality rate was 77.55%, with upper-gastrointestinal bleeding being the leading cause of death (42.11%); the second leading cause was secondary infection (36.84%), while the third was hepatorenal syndrome (21.05%). CONCLUSION: Gynura segetum related HSOS often presents as progressive hepatic congestion, portal hypertension and liver failure, simultaneously, with a high mortality and misdiagnosis rate.