Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Thursday, 12 / 09 / 2021

Abstract

ORIGINAL ARTICLE

Validation of the Nanjing Criteria for Diagnosing Pyrrolizidine Alkaloids-induced Hepatic Sinusoidal Obstruction Syndrome

Wei Zhang1,#, Lu Liu1,2,#, Ming Zhang1, Feng Zhang1, Chunyan Peng1, Bin Zhang1, Jun Chen3, Lin Li3, Jian He4, Jiangqiang Xiao1, Yanhong Feng5, Xunjiang Wang6, Aizhen Xiong6, Li Yang6, Xiaoping Zou1, Yuecheng Yu7,* and Yuzheng Zhuge1,*

1  Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
2  Department of Gastroenterology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
3  Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
4  Department of Imaging, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
5  Department of Hepatology, Nanjing Second Hospital, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
6  The Ministry of Education Key Laboratory for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
7  Liver Diseases Center of PLA and Department of Infectious Diseases, General Hospital of Eastern Theater Command, and Bayi Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
#These authors contributed equally to this work.
*Correspondence to: Yuzheng Zhuge, Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China. Tel: +86-15996289206, Fax: +86-25-83106666, E-mail:  This email address is being protected from spambots. You need JavaScript enabled to view it. ; Yuecheng Yu, Liver Diseases Center of PLA and Department of Infectious Diseases, General Hospital of Eastern Theater Command, and Bayi Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210008, China. ORCID: http://orcid.org/0000-0003-3480-1829. Tel: +86-13805168619, Fax: +86-25-84546576, E-mail:This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2021;9(3):345-352 DOI: 10.14218/JCTH.2020.00124
Received: November 19, 2020 Accepted: March 8, 2021 Published online: March 31, 2021

Abstract

Background and Aims:Hepatic sinusoidal obstruction syndrome (HSOS) is caused by toxic injury to sinusoidal endothelial cells in the liver. The intake of pyrrolizidine alkaloids (PAs) in some Chinese herbal remedies/plants remains the major etiology for HSOS in China. Recently, new diagnostic criteria for PA-induced HSOS (i.e. PA-HSOS) have been developed; however, the efficacy has not been clinically validated. This study aimed to assess the performance of the Nanjing criteria for PA-HSOS.

Methods:Data obtained from consecutive patients in multiple hospitals, which included 86 PA-HSOS patients and 327 patients with other liver diseases, were retrospectively analyzed. Then, the diagnostic performance of the Nanjing criteria and simplified Nanjing criteria were evaluated and validated. The study is registered in www.chictr.org.cn (ID: ChiCTR1900020784).

Results:The Nanjing criteria have a sensitivity and specificity of 95.35% and 100%, respectively, while the simplified Nanjing criteria have a sensitivity and specificity of 96.51% and 96.33%, respectively, for the diagnosis of PA-HSOS. Notably, a proportion of patients with Budd-Chiari syndrome (11/49) was misdiagnosed as PA-HSOS on the basis of the simplified Nanjing criteria, and this was mainly due to the overlapping features in the enhanced computed tomography/magnetic resonance imaging examinations. Furthermore, most of these patients (10/11) had occlusion or thrombosis of the hepatic vein, and communicating vessels in the liver were found in 8/11 patients, which were absent in PA-HSOS patients.

Conclusions:The Nanjing criteria and simplified Nanjing criteria exhibit excellent performance in diagnosing PA-HSOS. Thus, both could be valuable diagnostic tools in clinical practice.

Keywords

Drug-induced liver injury, Hepatic sinusoidal obstruction syndrome, Pyrrolizidine alkaloids, Sensitivity, Specificity

Journal of Clinical and Translational Hepatology 2021 vol. 9, 345-352  [ Html  ] [ PDF Full-text ]

© 2021 Authors. This is an Open Access article distributed under the terms of the  Creative Commons Attribution-Noncommercial 4.0 License(CC BY-NC 4.0), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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