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Effect of oral silymarin in patients with acute hepatotoxic mushroom poisoning: an analysis of poison center data.

  • 2025-12-11
  • Clinical toxicology (Philadelphia, Pa.) 64(2)
    • Theerapon Tangsuwanaruk
    • Phantakan Tansuwannarat
    • Achara Tongpoo
    • Kanyapak Mirin
    • Satariya Trakulsrichai

Study Design

Type
Observational
Sample size
n = 255
Population
255 patients aged 15 years or older who ingested foraged mushrooms, with either onset of gastrointestinal symptoms at 5 h or more or elevated AST or ALT activities without identifiable causes
Methods
Retrospective observational study; patients reported to Ramathibodi Poison Center, Thailand, from January 2016 to May 2024; multivariable risk regression and regression of means used
Duration
January 2016 to May 2024

Introduction

Intravenous silibinin may reduce mortality in patients with hepatotoxic mushroom poisoning, but it is unavailable in some countries. This study aimed to evaluate the effectiveness of oral silymarin as an alternative treatment for decreasing mortality.

Methods

This retrospective observational study included patients reported to Ramathibodi Poison Center, Thailand, from January 2016 to May 2024. Eligibility criteria were patients aged 15 years or older who ingested foraged mushrooms, with either onset of gastrointestinal symptoms at 5 h or more or elevated aspartate aminotransferase or alanine aminotransferase activities without identifiable causes. The primary outcome was in-hospital mortality. The secondary outcomes were acute liver failure, acute kidney injury, hospital length of stay, and adverse drug events. Multivariable risk regression and regression of means were used to estimate the adjusted risk difference while controlling for confounding variables.

Results

A total of 255 patients were included, with an overall mortality of 5.1%. Thirty-three patients (12.9%) received silymarin. The mortality rate in the silymarin group was 3.0%, which is lower than the 5.4% mortality rate in the non-silymarin group. After adjusting for potential confounders, silymarin was not associated with a decrease in mortality. The incidence of acute liver failure and hospital length of stay were not reduced in the silymarin group, though the incidence of acute kidney injury was reduced (adjusted risk difference = -13.9% [95% CI: -23.6 to -4.1%]; P = 0.005). There were no adverse drug reactions.

Discussion

Our findings were derived from retrospective data at a single poison center; further studies are warranted to evaluate the treatment benefits and cost-effectiveness.

Conclusions

We were unable to demonstrate a reduction in mortality, acute liver failure, or hospital length of stay associated with oral silymarin use. However, it appeared to decrease the incidence of acute kidney injury.

Research Insights

  • Thistle→Reduced Acute Kidney Injury

    the incidence of acute kidney injury was reduced (adjusted risk difference = -13.9% [95% CI: -23.6 to -4.1%]; P = 0.005)

    Effect
    Beneficial
    Effect size
    Small
  • Thistle→Reduced Acute Liver Failure

    The incidence of acute liver failure and hospital length of stay were not reduced in the silymarin group

    Effect
    Neutral
    Effect size
    Small
  • Thistle→Reduced Hospital Length of Stay

    The incidence of acute liver failure and hospital length of stay were not reduced in the silymarin group

    Effect
    Neutral
    Effect size
    Small
  • Thistle→Reduced Mortality Risk

    After adjusting for potential confounders, silymarin was not associated with a decrease in mortality.

    Effect
    Neutral
    Effect size
    Small

Adverse Events Reported

  • Thistle→adverse drug reactions

    There were no adverse drug reactions.

    Finding
    Reported
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