Korean J Intern Med.  2016 Jan;31(1):65-72. 10.3904/kjim.2016.31.1.65.

Early monitoring for detection of antituberculous drug-induced hepatotoxicity

Affiliations
  • 1Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea. 3939lee@naver.com

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.

Keyword

Drug-induced liver injury; Drug monitoring; Tuberculosis; Republic of Korea

MeSH Terms

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
Alanine Transaminase
Antitubercular Agents
Aspartate Aminotransferases
Biomarkers
Full Text Links
  • KJIM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr