1892. Anti-Tubercular Drug-Induced Liver Injury in Patients with Fatty Liver

TL;DR

This study finds that patients with fatty liver are at higher risk of liver injury from anti-tuberculosis drugs, suggesting the need for closer monitoring.

Contribution

The study identifies non-alcoholic fatty liver disease as a significant risk factor for anti-tubercular drug-induced liver injury.

Findings

The overall incidence of ATT-DILI was 25% in the study population.

Patients with fatty liver had a significantly higher incidence of DILI (36.6%) compared to those without fatty liver (17.4%).

Abstract

Anti-tubercular drugs are known to cause drug-induced liver injury (DILI) but limited
data is available to highlight risk factors for the development of ATT - DILI. Non
alcoholic fatty liver disease (NAFLD) has become a leading cause of chronic liver
disease. The study aims to bring out incidence and risk factors of ATT-DILI with
particular focus on NAFLD.

This was a prospective cohort study done at a tertiary care centre in North India.
Primary objective was to estimate the incidence of ATT-DILI in patients with fatty
liver. Other objectives were to compare the incidence of ATT-DILI in patients with and
without fatty liver and to study other risk factors for ATT-DILI. All outpatients being
initiated on Category I ATT were screened. Fibroscan or Ultrasound abdomen was done to
look for the presence of fatty liver. Serial liver function tests were done and patients
were followed up till they developed DILI or 2 months whichever was earlier (Figure
1).Figure 1:Workflow showing number of patients screened and included in the study

Workflow showing number of patients screened and included in the study

A total of 242 patients were screened and 152 patients were included. The mean age of
the study cohort was 35.4 years and 81 patients were male. Sixty out of 152 patients had
fatty liver.

The overall incidence of ATT-DILI was 25%. Patients with fatty liver had a
significantly higher incidence of DILI as compared to the incidence of DILI in patients
who did not have fatty liver (36.6% v/s 17.4%; p-value< 0.001). (Figure 2) Comparing
baseline characteristics, patients with DILI had lower serum albumin and higher baseline
ALT compared to patients who did not develop DILI. (Table 1) The median time to DILI was
14 days and there was no difference seen in time to DILI in both groups. Presence of
fatty liver was associated with development of DILI (Table 2).

Patients who did not have fatty liver had significantly higher incidence of hepatic
adaptation as compared to without fatty liver (28.2% v/s 23.3%; p-value=0.04).

The overall incidence of ATT-DILI is high in our study. Fatty liver was independently
associated with development of DILI. Patients with fatty liver need to be monitored
closely for development of DILI.

All Authors: No reported disclosures

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