CAM products associated with ACLF in 39.6% of patients with liver injury in retrospective cohort

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.