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CAM products associated with ACLF in 39.6% of patients with liver injury in retrospective cohortCAM products linked to liver failure and heavy metal contamination in patients

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Key Takeaway
Consider CAM use and heavy metal contamination in patients presenting with acute liver injury.

A retrospective cohort study analyzed 91 consecutive patients presenting with complementary and alternative medicine (CAM)-related adverse events at a South Indian tertiary center between 2021 and 2023. The study examined 386 implicated CAM products. The primary outcome was acute-on-chronic liver failure (ACLF) occurrence and mortality, compared against non-ACLF presentations.

Among all patients, 36 of 91 (39.6%) developed ACLF, representing a significantly increased risk (OR 5.20, P=0.004). Among patients with hepatic adverse events specifically, the ACLF rate was 41.9% (36/86). Mortality was substantially higher in patients who developed ACLF (14/36, 38.9%) compared to those who did not (6/55, 10.9%). Analysis of product contamination found heavy metals exceeding WHO limits, including mercury (34%), cadmium (25%), arsenic (21%), and lead (14%). Cadmium exposure above limits was associated with ACLF in 75.9% of cases versus 22.6% (P=0.004).

The study's main safety finding was that CAM-related adverse events could progress to the serious outcome of ACLF. Key limitations include the retrospective, observational design, which cannot establish causation, only association. The follow-up duration and specific patient comorbidities were not reported. The findings are relevant to practice in highlighting that patients presenting with liver injury should be systematically queried about CAM use, and that contaminated products may drive severe hepatic outcomes in this setting.

This study looked at 386 complementary and alternative medicine products linked to adverse events in 91 patients treated at a hospital in South India between 2021 and 2023. The team examined whether these products were connected to acute liver failure and death. They also tested the products for safety issues like heavy metal contamination, undisclosed animal parts, and fake pharmaceutical ingredients.

The results showed that 39.6% of patients experienced acute liver failure, a serious condition. Among those with liver failure, 38.9% died, compared to 10.9% of patients without liver failure. Testing revealed that many products contained high levels of mercury, cadmium, arsenic, and lead, which exceeded World Health Organization safety limits. Specifically, exposure to cadmium was strongly linked to liver failure in this group.

Readers should understand that this is a retrospective study, meaning researchers looked back at past data. Such studies can show links between events but cannot prove that one thing caused another. The findings highlight real safety concerns about certain products but do not mean all alternative medicines are dangerous. Patients should discuss any alternative treatments with their doctors before use.

What this means for you:
Some CAM products were linked to liver failure and contained unsafe levels of heavy metals in this study.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedMar 2026
View Original Abstract ↓
BackgroundComplementary and alternative medicine (CAM)-related hepatotoxicity is a growing global concern. We utilized multi-modal analysis to characterize CAM product safety and identify predictors of severe liver injury.MethodsThis retrospective study analyzed 386 CAM products from 91 consecutive patients (mean 4.2 products/patient) presenting with CAM-related adverse events at a tertiary center in South India (2021–2023). Product-level analyses characterize the CAM supply chain while patient-level analyses inform clinical outcome associations. Investigations included ingredient documentation, heavy metal quantification, and GC-MS compound profiling.ResultsThe mean patient age was 48.2 years (75.8% male). ACLF occurred in 39.6% of all patients (36/91) and 41.9% of those with hepatic adverse events (36/86), with associated mortality of 38.9% (14/36) compared to 10.9% (6/55) in non-ACLF presentations (OR 5.20, P = 0.004). Heavy metals exceeded WHO limits in many products: mercury (34%), cadmium (25%), arsenic (21%), and lead (14%). Cadmium exposure exceeding WHO limits showed a strong association with ACLF (75.9% vs 22.6%, P
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