Clinical features of liver injury induced by anti-tuberculosis drugs and related risk factors
10.3969/j.issn.1001-5256.2021.10.022
- VernacularTitle:抗结核药物导致肝损伤的临床特征及危险因素分析
- Author:
Deliang HUANG
1
;
Wei DAI
2
;
Jun CHEN
2
;
Xiaoguang YE
3
Author Information
1. Department of Infectious Diseases, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China;National Clinical Research Center for Infectious Diseases, Fourth Department of Liver Diseases, Medical Center for Liver Diseases, The Second Affiliated Hospital of Southern University of Science and Technology & Shenzhen Third People's Hospital, Shenzhen, Guangdong 518100, China
2. National Clinical Research Center for Infectious Diseases, Fourth Department of Liver Diseases, Medical Center for Liver Diseases, The Second Affiliated Hospital of Southern University of Science and Technology & Shenzhen Third People's Hospital, Shenzhen, Guangdong 518100, China
3. Department of Infectious Diseases, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Publication Type:Original articles_Other liver diseases
- Keywords:
Chemical and Drug Induced Liver Injury;
Tuberculosis;
Antitubercular Agents;
Disease Attributes;
Risk Factors
- From:
Journal of Clinical Hepatology
2021;37(10):2369-2375
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical features of liver injury induced by anti-tuberculosis drugs and related risk factors. Methods A total of 129 patients who were diagnosed with liver injury induced by anti-tuberculosis drugs in Shenzhen Third People's Hospital from January 2017 to December 2018 were enrolled and divided into abnormal liver function group with 51 patients (39.53%) and drug-induced liver injury (DILI) group with 78 patients (60.47%), and among these 129 patients, 13 (10.08%) had liver failure. A retrospective analysis was performed for their laboratory markers as well as treatment and prognosis data. The chi-square test was used for comparison of categorical data between two groups; the independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The multivariable logistic regression model was used to investigate the risk factors for DILI and liver failure. Results There were significant differences between the DILI group and the abnormal liver function group in chronic HBV co-infection ( χ 2 =5.616, P =0.018), asymptomatic liver injury ( χ 2 =9.451, P =0.002), liver failure ( χ 2 =9.453, P =0.002), need to adjust anti-tuberculosis regimen ( χ 2 =16.787, P < 0.001), time to identification of liver injury ( Z =-4.001, P < 0.001), time to liver function recovery ( Z =-1.735, P < 0.001), and hepatic encephalopathy ( χ 2 =4.114, P =0.043). The multivariate logistic regression analysis showed that time to identification of liver injury > 8 weeks (odds ratio [ OR ]=3.94, 95% confidence interval [ CI ]: 1.02-15.25, P =0.047) and asymptomatic liver injury ( OR =7.64, 95% CI : 1.63-35.86, P =0.010) were independent risk factors for DILI; chronic HBV co-infection ( OR =14.42, 95% CI : 2.66-78.09, P =0.002) and time to identification of liver injury > 8 weeks ( OR =11.97, 95% CI : 2.03-70.50, P =0.006) were independent risk factors for liver failure, while albumin ≥35 g/L ( OR =0.07, 95% CI : 0.01-0.51, P =0.010) was a protective factor. Conclusion Anti-tuberculosis drugs may induce severe liver injury, and HBV co-infection, asymptomatic liver injury, long time to identification of liver injury, and low albumin level may increase the risk of severe liver injury. Regular follow-up, liver function monitoring, appropriate nutritional support, and HBV screening are important for reducing the risk of liver injury during anti-tuberculosis therapy.
