Novel risk factors and early detection of anti tubercular treatment induced liver injury-Looking beyond American Thoracic Society Guidelines.
ATT remains the standard treatment for tuberculosis. Drug-induced liver injury (DILI) has been a long-standing concern in the treatment of tuberculosis (TB) infection.



To study the occurrence and risk factors of DILI in patients on ATT by regular clinical and biochemical monitoring.



200 patients, in whom ATT was started, were enrolled in the study. None of the patients with established risk factor for DILI as recognized by ATS guidelines was included in our study population. Regular clinical and liver function test monitoring was done at the commencement of ATT and then at 2, 4, and 8 weeks in the intensive phase subsequently at 4 and 6 months.



DILI developed in 16 patients. Among those, 10 patients (62.5%) developed early DILI and 6 patients (37.5%) developed late DILI. Female gender and extrapulmonary tuberculosis were found to be associated with increased risk of ATT-induced DILI, whereas age, BMI, and serum albumin were not found to significantly increase DILI risk.



DILI is a common problem among patients on ATT in our population. Early detection not only reduces the risk of developing Hepatic Failure but also prevents mortality.
Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India.
Muzamil
M
Latief
Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India. Electronic address: drwaseem.mw@gmail.com.
Waseem Raja
WR
Dar
Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India.
Najeebullah
N
Sofi
Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India.
Imtiyaz Ahmad
IA
Dar
Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India.
Basharat
B
Kasana
Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India.
Moomin
M
Hussain
Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India.
Faheem
F
Arshad
Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India.
Bashir Ahmad
BA
Shah
Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India.
Parvaiz Ahmad
PA
Koul
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012955:Societies, Medical; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*; D055815:Young Adult
D000995:Antitubercular Agents
Anti-tubercular treatment; Drug induced liver injury; Liver function tests