Clinical and biochemical profile of tuberculosis in patients with liver cirrhosis

Abstract

Background and Aims: Patients with liver cirrhosis are prone to tuberculosis (TB) because of immunocompromised status. However there is scarcity of data from India. The aim of this study was to elucidate the clinical and biochemical characteristics and treatment responses in TB patients with cirrhosis.Methods: All cases with TB and cirrhosis of liver detected over a 2-year period were enrolled. Cirrhosis was diagnosed based on clinical, biochemical, radiological and liver biopsy if available. Diagnosis of TB and drug induced hepatotoxicity was based on standard criteria for pulmonary and extra pulmonary TB. Treatment with antitubercular drugs includes rifampicin (R),isoniazid (I),ethambutol (E), pyrazinamide (Z), ofloxaxin (O) and tericox (T).Results: Fifty five cases of TB were diagnosed out of 2230 (M:F: 1782: 448)patients with cirrhosis with prevalence of 25/1000 patients. Base line characteristics of included patients were [Age, 52 (24–85), M:F (45:10),Child Pugh class (CPC) (A:B:C:6:34:15), aetiology (alcohol:viral:others:32:10:13)]. Extrapulmonary TB was more common in patients with cirrhosis (Pulmonary: Extrapulmonary: 29%: 71%, P =0.01). In extrapulmonary TB distribution was as (pleural effusion, n=10, nodal, n=10, intestinal, n=2, peritoneal, n=9, bone, n=2, disseminated, n=3, liver, n=2 and meningeal, n=1).CPC-A (n=6) received RHEZ, CPC- B (n=35) received RHEO (n=30) and CPC- C (n=15) received EOT (n=8)as the commonest regimen. Drug induced liver injury (DILI) was seen in 16 (29%) patients (n=8 from rifaximin and n=8 from isoniazid). Median duration of onset of DILI was 12 days (4–34) days. DILI was seen mainly in CPC- B (n=6) and CPC- C (n=10).Median duration of antitubercular treatment was 9months (6–18 months). Four patients died during hospital stay from CPC- C. None had drug induced liver failure.Conclusions: TB patients with liver cirrhosis show extrapulmonary involvement more frequently and had high incidence of drug induced liver injury. Background and Aims: Patients with liver cirrhosis are prone to tuberculosis (TB) because of immunocompromised status. However there is scarcity of data from India. The aim of this study was to elucidate the clinical and biochemical characteristics and treatment responses in TB patients with cirrhosis. Methods: All cases with TB and cirrhosis of liver detected over a 2-year period were enrolled. Cirrhosis was diagnosed based on clinical, biochemical, radiological and liver biopsy if available. Diagnosis of TB and drug induced hepatotoxicity was based on standard criteria for pulmonary and extra pulmonary TB. Treatment with antitubercular drugs includes rifampicin (R),isoniazid (I),ethambutol (E), pyrazinamide (Z), ofloxaxin (O) and tericox (T). Results: Fifty five cases of TB were diagnosed out of 2230 (M:F: 1782: 448)patients with cirrhosis with prevalence of 25/1000 patients. Base line characteristics of included patients were [Age, 52 (24–85), M:F (45:10),Child Pugh class (CPC) (A:B:C:6:34:15), aetiology (alcohol:viral:others:32:10:13)]. Extrapulmonary TB was more common in patients with cirrhosis (Pulmonary: Extrapulmonary: 29%: 71%, P =0.01). In extrapulmonary TB distribution was as (pleural effusion, n=10, nodal, n=10, intestinal, n=2, peritoneal, n=9, bone, n=2, disseminated, n=3, liver, n=2 and meningeal, n=1).CPC-A (n=6) received RHEZ, CPC- B (n=35) received RHEO (n=30) and CPC- C (n=15) received EOT (n=8)as the commonest regimen. Drug induced liver injury (DILI) was seen in 16 (29%) patients (n=8 from rifaximin and n=8 from isoniazid). Median duration of onset of DILI was 12 days (4–34) days. DILI was seen mainly in CPC- B (n=6) and CPC- C (n=10).Median duration of antitubercular treatment was 9months (6–18 months). Four patients died during hospital stay from CPC- C. None had drug induced liver failure. Conclusions: TB patients with liver cirrhosis show extrapulmonary involvement more frequently and had high incidence of drug induced liver injury.