Early monitoring for detection of antituberculous drug-induced hepatotoxicity.
10.3904/kjim.2016.31.1.65
- Author:
Chang Min LEE
1
;
Sang Soo LEE
;
Jeong Mi LEE
;
Hyun Chin CHO
;
Wan Soo KIM
;
Hong Jun KIM
;
Chang Yoon HA
;
Hyun Jin KIM
;
Tae Hyo KIM
;
Woon Tae JUNG
;
Ok Jae LEE
Author Information
1. Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea. 3939lee@naver.com
- Publication Type:Comparative Study ; Original Article
- Keywords:
Drug-induced liver injury;
Drug monitoring;
Tuberculosis;
Republic of Korea
- MeSH:
Adult;
Aged;
Alanine Transaminase/blood;
Antitubercular Agents/*adverse effects;
Aspartate Aminotransferases/blood;
Biomarkers/blood;
Chemical and Drug Induced Liver Injury/blood/*diagnosis/etiology;
Chi-Square Distribution;
Clinical Enzyme Tests;
Coinfection;
Drug Monitoring/*methods;
Drug Therapy, Combination;
Early Diagnosis;
Female;
Hepatitis/complications/diagnosis;
Humans;
*Liver Function Tests;
Logistic Models;
Male;
Middle Aged;
Multivariate Analysis;
Odds Ratio;
Predictive Value of Tests;
Retrospective Studies;
Risk Factors;
Time Factors
- From:The Korean Journal of Internal Medicine
2016;31(1):65-72
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: We investigated the time of onset of antituberculous drug-induced hepatotoxicity (ADIH) and related characteristics. METHODS: Adult patients (n = 1,031) treated with first-line antituberculous drugs between February 2009 and January 2013 were enrolled. RESULTS: Of the 1,031 patients, 108 patients (10.5%) developed ADIH a mean of 39.6 +/- 43.7 days after treatment initiation. Twenty-eight patients (25.9%) developed ADIH within 7 days, 73 (67.6%) within 30 days, and the rest after 30 days. The < or = 30-day group was characterized by higher peak alanine aminotransferase (ALT) level and a high proportion of patients with maintenance of first-line antituberculous drugs compared to the > 30-day group. In subgroup analysis, the < or = 7-day group was characterized by higher baseline aspartate aminotransferase and ALT, high proportion of patients with maintenance of first-line antituberculous drugs, and high proportion of patients with extrapulmonary tuberculosis compared to patients with ADIH that developed beyond 7 days. In multivariate analysis, serum ALT > 40 IU/L (odds ratio [OR], 2.995; 95% confidence interval [CI], 1.580 to 5.680; p = 0.001) and presence of anti-hepatitis C virus (OR, 4.204; 95% CI, 1.822 to 9.700, p = 0.001) were independent risk factors for development of ADIH. CONCLUSIONS: Approximately 70% of the cases of ADIH occurred in the first month of antituberculous treatment, and were associated with continuation of the first-line drug regimen.
