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 1, 2, 3 , Tsung-Hsing Hung 4, 5 , Hanoch Livneh 6 , I-Hsin Lin 7 , Ming-Chi Lu 5, 8 and Chia-Chou Yeh 7, 9 1 Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi 62247, Taiwan 2 Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan 3 Department of Nursing, Tzu Chi College of Technology, Hualien 97004, Taiwan 4 Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Chiayi 62247, Taiwan 5 School of Medicine, Tzu Chi University, Hualien 97004, Taiwan 6 Rehabilitation Counseling Program, Portland State University, Portland, OR 97207-0751, USA 7 School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97004, Taiwan 8 Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi 62247, Taiwan 9 Department of Chinese Medicine, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi 62247, Taiwan Correspondence to: Chia-Chou Yeh, email: yehcc0530@gmail.com Keywords: chronic hepatitis B; liver cirrhosis; mortality; Chinese herbal medicine; cohort study Received: November 28, 2017      Accepted: January 25, 2018      Published: April 06, 2018 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.