Patterns of Liver Injury and Adaptation in Patients With Abdominal Tuberculosis on Antituberculosis Treatment: A Prospective Cohort Study

Background

Extra-pulmonary tuberculosis is associated with a higher risk of drug-induced liver injury (DILI) with antituberculosis treatment (ATT). Nevertheless, hepatic dysfunctions in some patients can also regress to normalization due to hepatic adaptation (HA). Prospective data specifically addressing these issues in patients with abdominal tuberculosis (ATB) is lacking. This study was aimed to evaluate the patterns of hepatic injury, HA, and their predictors in patients with ATB receiving ATT.

Methods

This was a prospective cohort study involving 140 patients with ATB and normal baseline liver function tests (LFTs). Patients received standard four-drug ATT, and LFTs were serially monitored. Predictive factors were evaluated using multivariable logistic regression.

Results

LFT abnormalities occurred in 71 patients (50.7%). Of these, 20 (14.2%) met DILI criteria at first abnormality. Among the remaining 51, 18 (35.3%) progressed to DILI, while 33 (64.7%) showed spontaneous resolution, consistent with HA. Overall, 27.1% patients developed DILI, and 46.4% of LFT abnormalities resolved due to HA. The majority (89%) of DILI occurred within the first 8 weeks of treatment, and median time for HA was 21 days. Low serum albumin and vitamin D independently predicted DILI progression. Full reintroduction of ATT was successful in 65.8% of cases. Pyrazinamide was most commonly associated with reintroduction failure. None of DILI cases progressed to acute liver failure.

Conclusion

LFT abnormalities is common in ATB patients receiving ATT; however, nearly half experience spontaneous resolution due to HA. Hypoalbuminemia and vitamin D deficiency independently predicted progression to DILI, highlighting the need for vigilant LFT monitoring.