A prospective study of antituberculous drug-induced hepatotoxicity in an area endemic for liver diseases |
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Authors: | Hoda A Makhlouf Ahmed Helmy Ehab Fawzy Madiha El-Attar Hebat Alla G Rashed |
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Institution: | (1) Department of Chest Diseases, Faculty of Medicine, Assiut University, Assiut, 71111, Egypt;(2) Department of Tropical Medicine & Gastroenterology, Faculty of Medicine, Assiut University, Assiut, 71111, Egypt;(3) Gastroenterology Section, Department of Medicine MBC 46, King Faisal Specialist Hospital & Research Center, PO Box 3354, Riyadh, 11211, Saudi Arabia;(4) Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, 71111, Egypt |
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Abstract: | Purpose Identification of risk factors associated with antituberculosis drug-induced hepatotoxicity (anti-TB-DIH) is important, especially
in endemic area for TB and liver disease. This study assessed the incidence and risk factors of anti-TB-DIH in upper Egyptian
patients treated for active pulmonary and extra-pulmonary TB.
Methods A total of 100 consecutive TB patients were prospectively followed up both clinically and biochemically before and during
their course of anti-TB therapy with daily doses of isoniazid, rifampin, ethambutol, and pyrazinamide, or streptomycin.
Results Anti-TB-DIH developed in 15 (15%) patients within 15–60 days (median: 30 days) from the onset of therapy. Liver function normalized
in 10 (60%) patients within 2 weeks from cessation of therapy. No recurrence of DIH was observed after reintroduction of therapy.
Only 1 patient died from fulminant hepatic failure despite discontinuation of all anti-TB drugs. By univariate analysis, patients
with anti-TB-DIH had more pre-existing liver disease (P = 0.024; OR: 3.60; 95% CI: 1.16–11.18), lower body mass index (BMI; P = 0.037; OR: 3.73; 95% CI: 1.04–10.56), lower serum albumin (P = 0.035; OR: 3.31; 95% CI: 1.04–10.56), and more extensive disease (P = 0.033; OR: 3.50; 95% CI: 1.11–11). Age, gender, raised baseline transaminases level, inclusion of pyrazinamide, and inactive
hepatitis B or C carrier state were not significant risk factors of DIH. Using multivariate regression analysis, only pre-existing
liver disease and lower BMI of 20 kg/m2 or less were independent predictors of DIH (P = 0.024 and P = 0.047, respectively).
Conclusion Anti-TB-DIH is not uncommon, needs early recognition and treatment, and is more in patients with pre-existing liver disease
and low BMI. |
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Keywords: | Drug-induced liver disease Drug-induced hepatitis Side effects Adverse reactions Pulmonary tuberculosis Risk factors |
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