1.Early monitoring for detection of antituberculous drug-induced hepatotoxicity.
Chang Min LEE ; 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
The Korean Journal of Internal Medicine 2016;31(1):65-72
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.
Adult
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Aged
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Alanine Transaminase/blood
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Antitubercular Agents/*adverse effects
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Aspartate Aminotransferases/blood
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Biomarkers/blood
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Chemical and Drug Induced Liver Injury/blood/*diagnosis/etiology
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Chi-Square Distribution
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Clinical Enzyme Tests
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Coinfection
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Drug Monitoring/*methods
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Drug Therapy, Combination
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Early Diagnosis
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Female
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Hepatitis/complications/diagnosis
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Humans
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*Liver Function Tests
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Logistic Models
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Male
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Middle Aged
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Multivariate Analysis
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Odds Ratio
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Predictive Value of Tests
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Retrospective Studies
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Risk Factors
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Time Factors