Antituberculosis drug-induced liver injury in chronic hepatitis and cirrhosis.
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.
Park
Wan Beom
WB
Department of Internal Medicine, Seoul National University College of Medicine, 39 Boramae Road, Seoul, Republic of Korea.
Kim
Won
W
Lee
Kook Lae
KL
Yim
Jae-Joon
JJ
Kim
Moonsuk
M
Jung
Yong Jin
YJ
Kim
Nam Joong
NJ
Kim
Dong Hee
DH
Kim
Yoon Jun
YJ
Yoon
Jung-Hwan
JH
Oh
Myoung-don
MD
Lee
Hyo Suk
HS
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*
D000995:Antitubercular Agents; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase