Clinical Characteristics And Prognosis Of Drug-induced Liver Injury In Tuberculosis Patients With HBsAg Positive

Background and AimsChina is one of high prevalence of tuberculosis(TB)and chronic HBV infection countries.In recent years,there are more and more TB patients co-infected with HBV,and it is normal to find drug-induced liver injury during anti-tuberculosis treatment.The aim of this study was to find the clinical characteristics and prognosis of DILI in TB patients with HBsAg positive,in order to provide clues for therapy,improve the prognosis and reduce mortality.MethodsThe TB patients with HBsAg positive who needed for anti-tuberculosis treatment were selected into our study,which were hospitalized in the first affiliated hospital of Zhejiang University School of Medicine from January 2013 to June 2017.Basic information,laboratory examination of basic and time of liver injury or the end of follow-up,anti-tuberculosis therapy,antiviral therapy and timing,liver injury duration,survival status were recorded.All statistical analyses were performed by SPSS 22.0.ResultsTotal 96 patients were selected into this study,including 77 men(80.21%)and 19 women(19.79%),with an average age of(43.06±14.44)years.Of all patients,45.83%(44/96)developed liver injury,18.75%(18/96)had liver failure,and 7 patients died(7.29%).Clinical characteristics:(1)The patients with hypoalbuminemia could increase the incidence of liver injury(67.74%vs35.38%;P=0.003)and liver failure(35.48%vs10.77%,P=0.004)during anti-tuberculosis treatment.(2)HRZ anti-tuberculosis treatment has more risk of liver failure than HR anti-tuberculosis treatment(25.37%vs 3.45%,P=0.012),and may increase the incidence of liver injury(52.24%vs31.03%,P=0.056).(3)Prophylactic antiviral therapy can reduce the incidence of liver injury(11.36%vs75.00%,P<0.001)and liver failure(2.27%vs32.69%,P<0.001),and significant reduce liver injury duration(37.00±8.52vs69.34±33.41,P<0.001).(4)The mortality of ETV is lower than LAM+ADV(3.57%vs33.33%,P=0.004).(5)By multivariate analysis,found prophylactic antiviral treatment is independent protective factor for liver injury and liver failure(OR=0.018,95%CI:0.004-0.090,P<0.001;OR=0.058,95%CI:0.007-0.490,P=0.009),hypoalbuminemia is independent risk factor for liver injury and liver failure(OR=9.560,95%CI:1.931-47.320,P=0.006;OR=4.833,95%CI:1.345-17.362,P=0.016).(6)By Kaplan-Meier survival curves analysis:older,hypoalbuminemia,no prophylactic antiviral treatment,deterioration of liver function and coagulation were founded to be poor outcome of patients.ConclusionsHypoalbuminemia is independent risk factor for anti-tuberculosis drug-induced liver injury and liver failure of TB patients with HBsAg positive,and prophylactic antiviral treatment is independent protective factor for liver injury and liver failure.Older,hypoalbuminemia,no prophylactic antiviral treatment,deteriorationof liver function and coagulation were founded to be poor outcome of TB patients with HBsAg positive,so we suggest to attache great importance to these patients'monitoring,avoid the joint use of anti-tuberculosis drugs which have high incidence of liver damage,like PZA and use nucleoside antiviral drugs at the same time of anti-tuberculosis treatment.