Chinese herbal medicine therapy and the risk of mortality for chronic hepatitis B patients with concurrent liver cirrhosis: a nationwide population-based cohort study.

Tzung-Yi Tsai,Chia-Chou Yeh,Hanoch Livneh,Ming-Chi Lu,I-Hsin Lin,Tsung-Hsing Hung

doi:10.18632/oncotarget.24383

Abstract

Chronic hepatitis B (CHB) is increasingly recognized as a public health problem in Taiwan. After affected patients are diagnosed with contaminant liver cirrhosis (LC), adverse clinical outcomes, especially death, are common. This study aimed to investigate the effect of Chinese herbal medicine (CHM), an essential branch of Traditional Chinese medicine (TCM), on the mortality risk among CHB patients with contaminant LC. This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 1522 patients 20–70 years of age with newly diagnosed CHB with LC during 1998–2007. Among them, 508 (33.37%) had received CHM products after the onset of CHB (CHM users), and the remaining 1014 patients (66.63%) were designated as a control group (non-CHM users). All enrollees were followed until the end of 2012 to determine deaths during the study period. We applied the Cox proportional hazards regression model to compute the hazard ratio for the association of CHM use and the subsequent risk of death. During the follow-up period, 156 CHM users and 493 non-CHM users died. After controlling for potential confounders, CHM users were found to have a significantly reduced risk of death compared with non-CHM users by 56%, and the effect was predominantly observed among those treated with CHM for > 180 days. CHM therapy lowered the risk of death among CHB patients with contaminant LC, which supported CHM might provide further treatment options for those with chronic liver diseases.

Highlights

Ascites, hepatic encephalopathy, and esophageal variceal bleeding are the 3 major complications of cirrhosis
This study aimed to investigate the effect of Chinese herbal medicine (CHM), an essential branch of Traditional Chinese medicine (TCM), on the mortality risk among Chronic hepatitis B (CHB) patients with contaminant liver cirrhosis (LC)
The mortality rate was lower in CHM users than in non-CHM users (42.80 vs 123.31, respectively, per 1000 person– years (PY)), with an adjusted hazard ratio [3] of 0.44 (95% confidence interval [confidence intervals (CI)]: 0.36–0.52) (Table 2)

Summary

Introduction

Hepatic encephalopathy, and esophageal variceal bleeding are the 3 major complications of cirrhosis. A recent 15-year cohort study of 112,458 patients with vertigo showed that those receiving CHM had a significantly lower risk (36%) of stroke than did those who did not receive CHM [4] Another randomized controlled trial conducted among 352 individuals with chronic obstructive pulmonary disease compared the effectiveness of combining conventional Western medicine and several Chinese herbal products for 1 year [5], and reported that integrating CHM and Western medicine significantly improved pulmonary function, quality of life, and psychological health (mood and depression). In a prior study, we found that the use of CHM was associated with a significantly reduced risk of hepatocellular carcinoma (HCC) in patients with CHB [6] These findings indicated that the integration of CHM into allopathic clinical practice is likely to contribute to favorable outcomes

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