Incidence and risk factors of antituberculosis drug-induced liver injury in India: A systematic review and meta-analysis.

IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY

Indian Journal of Gastroenterology Pub Date : 2024-09-03 DOI:10.1007/s12664-024-01643-w

Ramesh Kumar, Abhishek Kumar, Rishabh Patel, Sabbu Surya Prakash, Sudhir Kumar, Himanshu Surya, Sudheer Marrapu

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引用次数: 0

Abstract

Background: Antituberculosis drug-induced liver injury (ATDILI) is a significant problem of tuberculosis treatment. This systematic review and meta‑analysis aimed at evaluating the incidence and risk factors of ATDILI in adult patients with tuberculosis in India.

Methods: Five electronic databases were searched comprehensively for studies on Indian adult patients with tuberculosis investigating the incidence and/or risk factors of ATDILI. The relevant data was pooled in a random or fixed-effect model to calculate the pooled incidence with a 95% confidence interval (CI), standardized mean difference (MD) or odds ratio (OR).

Results: Following the screening of 3221 records, 43 studies with 12,041 tuberculosis patients were finally included. Based on the random effect model, the pooled incidence of ATDILI was 12.6% (95% CI, 9.9-15.3%, p < 0.001, I² = 95.1%). The pooled incidence was higher in patients with daily treatment regimen compared to the thrice weekly regimen (16.5% vs. 3.5%). The concurrent hepatitis B or C infection, alcohol consumption and underlying chronic liver disease were associated with high incidence of ATDILI. The pooled incidence of acute liver failure (ALF) among ATDILI patients was 6.78% (95% CI 3.9-9.5%). Female gender (OR 1.24), older age (MD 0.26), lean body mass index (OR 3.8), hypoalbuminemia (OR 3.09), N-acetyltransferase slow acetylator genotypes (OR 2.3) and glutathione S-transferases M null mutation (OR 1.6) were found to be associated with an increased risk of ATDILI. The pooled mortality rate of ATDILI patients was 1.72% (95% CI 0.4-3.0%) overall and 71.8% (95% CI 49.3-94.2%) in case of ALF.

Conclusion: Overall, 12.6% patients of tuberculosis in India developed ATDILI when combination of first-line antituberculosis drugs was used. An average of 7% of ATDILI patients progressed to ALF which had a high mortality rate. Older age, female, poor nutritional status and some genetic polymorphisms were identified as significant risk factors.

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印度抗结核药物诱发肝损伤的发病率和风险因素：系统回顾和荟萃分析。

背景：抗结核药物引起的肝损伤（ATDILI）是结核病治疗中的一个重要问题。本系统综述和荟萃分析旨在评估印度成年肺结核患者中 ATDILI 的发生率和风险因素：方法：在五个电子数据库中全面搜索了有关印度成年肺结核患者的研究，这些研究调查了 ATDILI 的发生率和/或风险因素。通过随机或固定效应模型对相关数据进行汇总，计算出汇总发病率及 95% 置信区间 (CI)、标准化平均差 (MD) 或几率比 (OR)：结果：在筛选了 3221 份记录后，最终纳入了 43 项研究，涉及 12041 名肺结核患者。根据随机效应模型，ATDILI 的总发病率为 12.6%（95% CI，9.9%-15.3%，P 2 = 95.1%）。与每周三次治疗方案相比，每日治疗方案患者的汇总发病率更高（16.5% 对 3.5%）。并发乙型或丙型肝炎感染、饮酒和潜在慢性肝病与 ATDILI 的高发生率有关。ATDILI患者中急性肝功能衰竭（ALF）的总发病率为6.78%（95% CI 3.9-9.5%）。研究发现，女性（OR 1.24）、高龄（MD 0.26）、瘦体重指数（OR 3.8）、低白蛋白血症（OR 3.09）、N-乙酰转移酶慢乙酰化基因型（OR 2.3）和谷胱甘肽 S-转移酶 M 基因缺失突变（OR 1.6）与 ATDILI 风险增加有关。ATDILI患者的总死亡率为1.72%（95% CI 0.4-3.0%），ALF患者的总死亡率为71.8%（95% CI 49.3-94.2%）：总的来说，在使用一线抗结核药物的情况下，印度有 12.6% 的结核病患者出现了 ATDILI。平均有 7% 的 ATDILI 患者发展为 ALF，死亡率很高。老年、女性、营养不良和一些基因多态性被认为是重要的风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Indian Journal of Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

3.90

自引率

10.00%

发文量

期刊介绍： The Indian Journal of Gastroenterology aims to help doctors everywhere practise better medicine and to influence the debate on gastroenterology. To achieve these aims, we publish original scientific studies, state-of -the-art special articles, reports and papers commenting on the clinical, scientific and public health factors affecting aspects of gastroenterology. We shall be delighted to receive articles for publication in all of these categories and letters commenting on the contents of the Journal or on issues of interest to our readers.