Factors Enhancing Drug-induced Hepatotoxicity among Thai Patients with TB

Abstract

Introduction: Drug-Induced Hepatotoxicity (DIH) is usually found in patients with Tuberculosis (TB) who have received the standard anti-TB treatment due to the specific drugs in the standard regimen as well as other factors. Hepatotoxicity is the main cause of drug discontinuation and influences drug resistance and fulminant hepatitis in patients with TB. Aim: This study aims to assess the factors enhancing DIH in patients with TB who received the standard anti-TB regiment in Phichit Hospital, Thailand. Materials and Methods: A retrospective study was used to examine factors that enhanced DIH in 327 new patients with TB who received the standard anti-TB treatment at the TB-clinic in Phichit Hospital from October 1st, 2016 to September 30th, 2018. Data was collected from medical and laboratory records at the TB clinic. The univariate and multivariate logistic regression were used to assess factors enhancing DIH in patients with TB, reported using an Adjusted Odd Ratio (AOR) of 95% CI and a p-value of <0.05. Results: The results of this study confirmed that malnutrition was positively associated with increased risk of DIH development {AOR 4.40 (1.26 to 12.26), p=0.01}. In addition, an age of >60 years was associated with an increased risk of DIH development {AOR 2.87 (95% CI 1.16 to 7.14), p=0.02}. Conclusion: For TB patients, being over 60-year-old and malnutrition are significant factors related to DIH. Therefore, the new patients with TB should receive the screening for present chronic liver disease, including AST and ALT whenever feasible, and nutritional assessment should be done for elderly patients before start of anti-TB treatment.