Effect of scheduled monitoring of liver function during anti-Tuberculosis treatment in a retrospective cohort in China

Shanshan Wu,Yanli Yuan,Xiaozhen Lv,Yuan Zhang,Peiyuan Deng,Zhirong Yang,Siyan Zhan,Feiying Liu,Yinyin Xia,Shiming Cheng,Xiaomeng Wang,Shaowen Tang,Dehua Tu,Daiyu Hu

doi:10.1186/1471-2458-12-454

Abstract

BackgroundData on effect of regular liver function monitoring during anti-TB treatment is limited in China. This study aimed to evaluate the effects of scheduled liver function monitoring on identification of asymptomatic liver damage and anti-TB treatment outcomes during anti-TB treatment.MethodsA retrospective analysis was performed based on a national-level cohort study. A total of 273 patients developing liver dysfunction were divided into two groups, 111 patients who were diagnosed through scheduled liver function test within two months after initiation of anti-TB treatment formed scheduled monitoring group, others who were diagnosed due to developing symptoms formed passive detection group (n = 162). The two groups were compared through clinical features, prognosis of liver dysfunction and impact on anti-TB treatment using propensity score weighting analysis.Results33.3% of 273 patients did not have any clinical symptoms, including 8 with severe hepatotoxicity. 1.8% in scheduled monitoring group and 11.1% in passive detection group required hospitalization (P = 0.004). Regarding the prognosis of liver dysfunction, most patients recovered, no death happened in scheduled monitoring group while 3 died in passive detection group. In terms of impact on anti-TB treatment, 35.1% in scheduled monitoring group and 56.8% in passive detection group changed their anti-TB treatment (P = 0.001).ConclusionsScheduled monitoring is effective in identifying asymptomatic liver damage, reducing hospitalization rate and improving compliance of anti-TB treatment.

Highlights

Data on effect of regular liver function monitoring during anti-TB treatment is limited in China
Baseline characteristics Of the 273 patients with liver dysfunction, 111 patients were in scheduled monitoring group while 162 patients were in passive detection group
Among the demographic features and weight, there was no significant difference between the two study groups

Summary

Introduction

Data on effect of regular liver function monitoring during anti-TB treatment is limited in China. As the second highest TB burden country in the world, China accounted for an estimated 12% of all TB cases worldwide [1]. Standard shortcourse chemotherapy regimen, which comprises of a combination of Isoniazid(H), Rifampicin(R), Pyrazinamide(Z), Ethambutol(E) and Streptomycin(S) for 6–9 months is recommended by WHO and currently used in most high TB burden countries including China[2]. Due to the long duration of therapy and concurrent use of multiple drugs, adverse effects are regarded as the most important clinical consideration in patients undergoing anti-TB treatment [3]. Hepatotoxicity is the most serious one, which leads to high morbidity and mortality, and diminishes anti-TB treatment effectiveness owing to non-adherence [4,5,6,7]

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