Analysis of influencing factors of acute liver failure in 147 patients with liver injury induced by antituberculosis drugs

Abstract

Abstract: Objective To explore the clinical and laboratory characteristics of patients with liver injury induced by anti-tuberculosis drugs, and to determine the predictive factors of acute liver failure (ALF). Methods A total of 147 patients with anti-tuberculosis drug-induced liver injury were divided into an ALF group and a non-ALF group based on the presence of acute liver failure between January 2016 and December 2022. Demographic characteristics, clinical symptoms, and laboratory results were compared between these two groups. Risk factors for the occurrence of acute liver failure were analyzed by univariate and multivariate logistic regression analysis. Results In the ALF group, there was a significantly higher incidence of previous hepatitis history, longer duration of treatment, and a greater proportion of Hy's 's law at 44.2%, 51 (73, 328) days and 51.9%, respectively, compared to 18.9%, 24 (219) days and 14.7% in the non-ALF group (P<0.05). Additionally, clinical symptoms and laboratory findings revealed that patients in the ALF group exhibited a significantly higher prevalence of jaundice, nausea, ascites, abdominal distension, pruritus, elevated levels of ALT, AST, ALP, total bilirubin, direct bilirubin, PT, WBC and alpha-fetoprotein [90.4%, 53.8%, 42.3%, 36.5%, 23.1%, 243 (25, 2024) U/L, 134 (75, 1542) U/L, 141 (79, 530) U/L, 265 (27, 528) μmol/L, 151 (10, 289) μmol/L, 18.5 (3.1, 56.7) s, 6.1 (2.8, 49.6)×10⁹/L and 25.7 (2.4, 1870) ng/mL] compared to the non-ALF group [20.0%, 20.0%, 13.7%, 14.7%, 10.5%, 116 (12, 724) U/L, 88 (27, 479) U/L, 86 (61, 646) U/L, 14 (6, 138) μmol/L, 7 (3, 102) μmol/L, 12.2 (9.8, 16.3) s, 5.2 (2.1, 25.6) ×10⁹/L and 2.3 (0.7, 3021.1) ng/mL] (P<0.05). Furthermore, the univariate logistic regression analysis identified AST level, TBil level, WBC count, PLA count, history of previous hepatitis, PT, DBil level, AFP level, Alb level, ALT level, ALP level, treatment duration, jaundice, abdominal distension, nausea, vomiting, pruritus, and a positive Hy's law as potential risk factors for the development of ALF during anti-tuberculosis therapy. Additionally, the multivariate logistic regression analysis indicated that AST level, TBil level, WBC count, PLA count, and history of previous hepatitis were strong predictors of ALF. Conclusion Elevated serum bilirubin, WBC count, AST level, low platelet count ,and a history of previous hepatitis are found to be independent predictors of acute liver failure in patients who have experienced liver injury due to anti-tuberculosis medications.

Key words: Drug-induced liver injury, Acute liver failure, Risk factor

ZHANG Zhao-jun, LIU Yue. Analysis of influencing factors of acute liver failure in 147 patients with liver injury induced by antituberculosis drugs[J]. Chinese Hepatolgy, 2024, 29(5): 552-556.

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