Association Between Co-infection With Hepatitis B Virus And Liver Injury And Outcome Among Patients With Anti-tuberculosis Treatment:Risk Factors Analysis

ObjectiveTo summarize and analyze the clinical characteristics of the patients with liver injury during anti-tuberculosis treatment,and investigate the association between co-infectio n hepatitis B virus(HBV)and liver injury,liver failure and outcome during anti-tuberculo s is treatment.MethodsIn this retrospective,single-center study,we included 129 confirmed cases of liver injury with anti-tuberculosis drug in The Third People’s Hospital of Shenzhen from January1,2017 to December 22,2018.Clinical,laboratory,treatment and outcome data were collected and analyzed.To investigate the relation between HBV and liver injury,different level of liver injury and outcome by multiple logistic regression analysis.Resultof 129 hospitalized patients,the average age was 41.64±16.6 years,including 95 males and 34 females.Among 129 patients,26 patients co-infection HBV(TB-HBV group)and103 without HBV(TB group).78 patients had suffered drug-induced liver injury and 13 had liver function failure,21 patients had liver injury and 10 had liver function failure in TBHBV group.There was a positive correlation between HBV and the risk of liver injury and liver failure.Compared to TB group,the crude ORs for drug-induced liver injury and liver function failure for TB-HBV were 3.4(95 percent confidence interval [CI]: 1.2-9.7)and20.8(95%CL:5.2-84)respectively.After adjustment for age,sex,cirrhosis,co-infectio n HIV,onset times of liver injury and albumin(ALB),the adjusted ORs for liver functio n failure for patients with HBV was 40.9(95%CL: 4.8-345.6).Compared to TB+<21d group and TB+≥21d group,HBV+<21d group、HBV+≥21d group had a higher risk of developing drug-induced liver injury and liver failure in onset times of liver injury subgroup analyses.The subgroup analyses also revealed that HBV+≥21d group had a higher risk of developing drug-induced liver injury and liver failure than HBV+<21d group.We found that HBV was a risk factor for poor outcome(OR:7.1,95%CI:1.3-38.5,P=0.02)and high level of ALB(≥35g/L)was the protective factor(OR:0.2,95%CI:0.0-0.8,P=0.02)in univariate and multivariate analyses of prognostic factor.To further assess the effect of HBV on the clinical outcome of patients with liver injury during anti-tuberculo s is treatment,kaplan-Meier(K-M)survival curve analysis was performed,we found that TBHBV group had a higher risk of developing poor outcome than TB group.Similar findings were obtained When analyses were run stratified by onset times of liver injury,we found that HBV+≥21d group had a lower overall survival than HBV+<21d groupConclusionsCo-infection with hepatitis B virus is a risk factor for liver injury,liver failure and poor outcome in patients with anti-tuberculosis treatment.And the later the onset times of liver injury,the higher risk of drug-induced liver injury and liver failure,and lower rate of overall survive in TB-HBV coinfection patients.