Risk factors for anti-tuberculosis drug-induced liver injury in treatment-naive tuberculosis patients / 中华传染病杂志

ABSTRACT

Objective:To investigate the risk factors for anti-tuberculosis drug-induced liver injury (ATB-DILI) in treatment-naive tuberculosis patients, and to provide evidence to avoid the occurrence of ATB-DILI in treatment-naive tuberculosis patients receiving anti-tuberculosis drug treatment.Methods:A retrospective case-control study was carried out in 177 treatment-naive tuberculosis patients admitted to the Third Hospital of Hebei Medical University from January 2014 to December 2019. According to whether developed ATB-DILI during anti-tuberculosis treatment, the patients were divided into non-ATB-DILI group and ATB-DILI group. General basic data of sex, age and body mass index, hepatic biological parameters, prothrombin time, serum ferritin level, basic liver condition and the number of first line hepatotoxic anti-tuberculosis drugs were collected. Mann-Whitney U test and chi-square test were used for statistical analysis, and multi-factor logistic regression analysis was adopted to analyze risk factors for ATB-DILI in treatment-naive tuberculosis patients. Results:The incidence of ATB-DILI was 20.3%(36/177) in the 177 treatment-naive tuberculosis patients. Alanine aminotransferase (ALT), aspartate aminotransferase, incidence of high serum ferritin and the number of first line hepatotoxic anti-tuberculosis drugs were significantly different between non-ATB-DILI group and ATB-DILI group ( Z=-2.13, Z=-2.08, χ2=9.08 and Z=-2.79, respectively, all P<0.050). Multivariate logistic regression analysis showed that chronic viral liver disease (odds ratio ( OR)=9.675, P<0.001), the number of first line hepatotoxic anti-tuberculosis drugs ( OR=4.863, P=0.001), baseline ALT level ( OR=1.016, P=0.011) and high serum ferritin level ( OR=3.336, P=0.018) were the independent risk factors for ATB-DILI. The number of first line hepatotoxic anti-tuberculosis drugs (regression coefficient was 1.582) and baseline ALT level (regression coefficient was 0.016) were both positively correlated with the occurrence of ATB-DILI. Conclusions:Chronic viral liver disease, the number of first line hepatotoxic anti-tuberculosis drugs, higher baseline ALT level and high serum ferritin level are the independent risk factors for ATB-DILI.