TY - JOUR
T1 - Antituberculosis Drug-induced Liver Injury in Children
T2 - Incidence and Risk Factors During the Two-month Intensive Phase of Therapy
AU - Gafar, Fajri
AU - Arifin, Helmi
AU - Jurnalis, Yusri D.
AU - Yani, Finny F.
AU - Fitria, Najmiatul
AU - Alffenaar, Jan-Willem
AU - Wilffert, Berend
PY - 2019/1
Y1 - 2019/1
N2 - Background: As one of the most frequent and serious adverse reactions during tuberculosis (TB) treatment, antituberculosis drug-induced liver injury (ATLI) in children has been studied insufficiently compared with adults. We aimed to determine the incidence and risk factors of ATLI in children during the first 2 months of TB therapy.
Methods: A total of 41 children with TB and treated with first-line anti-TB drugs were prospectively followed-up for the development of ATLI. Liver function tests were performed at baseline and after 2 weeks of therapy. Subsequent tests were conducted at 4, 6 and 8 weeks if the initial 2-week measurement was abnormal or if symptoms of hepatotoxicity were reported.
Results: ATLI was detected in 11 (27%) patients within 14 to 42 days from the start of therapy, with most of them (54%) occurred after 2 weeks. TB treatment was stopped immediately in 6 of 11 patients who developed ATLI, and no recurrent hepatotoxicity after drug reintroductions in these patients. Univariate analysis showed that ATLI was significantly associated with TB meningitis (P < 0.01), hypoalbuminemia (P < 0.05) and hepatotoxic comedications (P < 0.01). Age, sex, nutritional status, HIV status and baseline liver function abnormalities were not associated with ATLI. Multivariate analysis identified hypoalbuminemia and hepatotoxic comedications (both P < 0.1) tend to be independently associated with ATLI.
Conclusions: Children with hypoalbuminemia and use of hepatotoxic comedications are suggested to be monitored closely for the development of ATLI.
AB - Background: As one of the most frequent and serious adverse reactions during tuberculosis (TB) treatment, antituberculosis drug-induced liver injury (ATLI) in children has been studied insufficiently compared with adults. We aimed to determine the incidence and risk factors of ATLI in children during the first 2 months of TB therapy.
Methods: A total of 41 children with TB and treated with first-line anti-TB drugs were prospectively followed-up for the development of ATLI. Liver function tests were performed at baseline and after 2 weeks of therapy. Subsequent tests were conducted at 4, 6 and 8 weeks if the initial 2-week measurement was abnormal or if symptoms of hepatotoxicity were reported.
Results: ATLI was detected in 11 (27%) patients within 14 to 42 days from the start of therapy, with most of them (54%) occurred after 2 weeks. TB treatment was stopped immediately in 6 of 11 patients who developed ATLI, and no recurrent hepatotoxicity after drug reintroductions in these patients. Univariate analysis showed that ATLI was significantly associated with TB meningitis (P < 0.01), hypoalbuminemia (P < 0.05) and hepatotoxic comedications (P < 0.01). Age, sex, nutritional status, HIV status and baseline liver function abnormalities were not associated with ATLI. Multivariate analysis identified hypoalbuminemia and hepatotoxic comedications (both P < 0.1) tend to be independently associated with ATLI.
Conclusions: Children with hypoalbuminemia and use of hepatotoxic comedications are suggested to be monitored closely for the development of ATLI.
KW - TUBERCULOSIS
KW - ANTITUBERCULOSIS DRUGS
KW - Drug-Induced Liver Injury
KW - CHILDREN
KW - RISK FACTORS
UR - https://journals.lww.com/pidj/Fulltext/2019/01000/Antituberculosis_Drug_induced_Liver_Injury_in.11.aspx
U2 - 10.1097/INF.0000000000002192
DO - 10.1097/INF.0000000000002192
M3 - Article
SN - 0891-3668
VL - 38
SP - 50
EP - 53
JO - Pediatric infectious disease journal
JF - Pediatric infectious disease journal
IS - 1
ER -