title: Antituberculosis drug-induced liver injury in chronic hepatitis and cirrhosis.
abstract: OBJECTIVE
  To evaluate the incidence, risk factors and outcomes for anti-tuberculosis (TB) drug-induced liver injury (DILI) in patients with chronic liver disease including cirrhosis.
  
  
  METHODS
  A total of 107 patients with chronic liver disease were assessed for anti-TB DILI. Anti-TB DILI was defined as elevation of alkaline phosphatase (ALP), aspartate transaminase, or alanine transaminase, or an increase in Child-Turcotte-Pugh score within 2 months of initiating anti-TB medication. The risk factors for anti-TB DILI were evaluated by multivariate logistic regression analysis.
  
  
  RESULTS
  Fifty-eight (54%) patients had cirrhosis. Of 93 patients receiving one or more hepatotoxic anti-TB drugs, 18 (17%) experienced DILI: 11 (24%) among 46 patients with chronic hepatitis and 7 (15%) among 46 patients with compensated liver cirrhosis (P = 0.271). Independent risk factors for DILI were female sex, number of hepatotoxic anti-TB drugs administered and baseline ALP levels but not cirrhosis itself. Of the 18 patients with DILI, 13 (72%) successfully completed anti-TB treatment after switching to less hepatotoxic drug regimens.
  
  
  CONCLUSIONS
  Hepatotoxic anti-TB drugs may be safely used in the patients with chronic liver disease including compensated cirrhosis if number of hepatotoxic drugs used is adjusted appropriately.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 39 Boramae Road, Seoul, Republic of Korea.
authors.forename: Wan Beom
authors.initials: WB
authors.lastname: Park
authors.forename: Won
authors.initials: W
authors.lastname: Kim
authors.forename: Kook Lae
authors.initials: KL
authors.lastname: Lee
authors.forename: Jae-Joon
authors.initials: JJ
authors.lastname: Yim
authors.forename: Moonsuk
authors.initials: M
authors.lastname: Kim
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Jung
authors.forename: Nam Joong
authors.initials: NJ
authors.lastname: Kim
authors.forename: Dong Hee
authors.initials: DH
authors.lastname: Kim
authors.forename: Yoon Jun
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Yoon
authors.forename: Myoung-don
authors.initials: MD
authors.lastname: Oh
authors.forename: Hyo Suk
authors.initials: HS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001219:Aspartate Aminotransferases / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology*; D005260:Female; D006521:Hepatitis, Chronic / Q000150:complications*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014376:Tuberculosis / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase