Predicting antitubercular drug-induced liver injury and its outcome and introducing a novel scoring system

Selvin Raj Mani, Ramya Iyyadurai, Ajay Mishra*, Krishna Manjunath, Jasmin Prasad, Jeyaseelan Lakshmanan, Bijesh Yadav, Alex Reginald, Sudha Jasmine, Samuel Hansdak, Anand Zachariah

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Tuberculosis (TB) is a major global health problem, mainly in developing countries. Despite the availability of highly effective first-line antitubercular (ATT) drugs, ATT drug-induced liver injury (ATT DILI) leads to treatment interruption and consequently loss of therapeutic efficacy. Methods: In this prospective cohort study from India, all consecutive patients who met inclusion criteria and started on ATT were included. The incidence, risk factors, and outcome of ATT DILI were determined. A clinical prediction score for ATT DILI was derived. Results: A total of 393 patients were included. The incidence of ATT DILI was 9.7% (95% confidence interval 7%-13.2%). HIV infection, daily regimen, disseminated disease, and chronic liver disease were identified as significant risk factors (P < 0.05) for developing DILI. A prediction score derived from the risk factors showed that a score of >5 could predict DILI with a sensitivity of 74% and a specificity of 67%. All-cause mortality in DILI was 4.7%. Conclusion: The incidence of ATT DILI was 9.7% in our cohort with higher incidence among the patients on daily regimen. The study suggests that the combination of risk factors of extensive TB disease, HIV infection, chronic liver disease, and under nutrition increases the vulnerability to DILI, particularly with daily treatment regimen, emphasizing the role of acquired risk factors in the development of DILI.

Original languageEnglish
Pages (from-to)116-121
Number of pages6
JournalInternational Journal of Mycobacteriology
Volume10
Issue number2
DOIs
Publication statusPublished - Apr 1 2021
Externally publishedYes

Keywords

  • Drug-induced liver injury
  • outcome
  • scoring
  • tuberculosis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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