Gynura segetum-related hepatic sinusoidal obstruction syndrome: a national multicenter clinical study

Abstract

Objective To investigate the clinical features, diagnosis and treatment of Gynura segetum-related hepatic sinusoidal obstruction syndrome (HSOS). Methods From January 2010 to May 2017, 458 hospitalized patients with HSOS from 29 hospitals were enrolled, and among them 239 cases were Gynura segetum-related HSOS. The diagnostic value of clinical signs in Gynura segetum-related HSOS were evaluated by Seattle criteria which used in HSOS caused by hemopoietic stem cells transplantation. The pathological diagnosis of liver biopsy was taken as gold standard. The diagnostic value of computed tomography (CT)/magnetic resonance imaging (MRI) in Gynura segetum-related HSOS was also investigated. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Kappa value were used for the assessment of diagnostic value. Cox regression analysis was performed for prognosis analysis. Results Among 362 patients with drugs-related HSOS, 239 cases (66.02%) was Gynura segetum-related HSOS and 232(97.07%) of the 239 patients with Gynura segetum-related HSOS presented with ascites. The diagnostic sensitivity and specificity of ascites in HSOS were 97.07% and 75.86%, respectively, and the Kappa value was 0.751. The diagnostic sensitivities of patchy map-like enhancement and (or) heterogeneous hypoattenuation of CT or inhomogeneous signal of MRI were 100.0% and 97.4%, respectively; and the specificities were 88.9% and 100.0%, respectively, and both of the Kappa value were more than 0.75, with excellent consistency. The accuracies of patchy enhancement, heterogeneous hypoattenuation of CT or inhomogeneous signal of MRI and ascites were all over 90%. Among 239 patients with Gynura segetum-related HSOS, 229 (95.82%) patients were treated with hepatoprotectants and diuretics, and 105 (43.93%) patients received anticoagulant drugs. The mortality rate was 8.37% (20/239). The percentage of patients with no improvement or deterioration was 17.57% (42/239). Increased total bilirubin and lactic dehydrogenase levels were related with poor prognosis (the relative risk was 1.012 and 1.009, respectively; both P<0.05). Conclusions Gynura segetum is a major cause of hospitalized patients with HSOS in China. Ascites is the major clinical manifestation. The patchy enhancement, heterogeneous hypoattenuation of CT or inhomogeneous signal of MRI are the main CT/MRI signs of HSOS. There are no reliable and effective treatments for Gynura segetum-related HSOS and the mortality is relatively low. Key words: Hepatic sinusoidal obstruction syndrome; Pyrrolizidine alkaloids; Multicenter study; Retrospective studies