Oxidative stress and ER stress may contribute to drug-induced hepatitis in tuberculous meningitis

Background: Study of oxidative stress and endoplasmic reticulum (ER) stress markers in drug induced hepatitis (DIH) associated with tuberculous meningitis (TBM) has not been done. Such a study may provide information on the role of stress in DIH. Objective: To report the role of oxidative stress and ER stress in DIH associated with TBM and their effect on outcome of patients. Method: Demographic and clinical information about TBM patients including stage of TBM, duration of illness, Magnetic Resonance Imaging (MRI) findings, laboratory markers, oxidative and ER stress markers were recorded. These markers were compared in patients with and without DIH. Survival analysis between DIH and no DIH patients was done using Kaplan-Meier analysis and the predictors of outcome were evaluated using Cox regression analysis. Results: Out of 92 patients with TBM, 36 (39.1%) developed DIH. There was significant alteration in oxidative stress and ER stress markers compared to baseline and following recovery from DIH. At the time of discharge 58.3% patients with DIH had poor outcome (mRS> 2). Kaplan-Meier analysis of survival revealed that the proportion of the patient's survival was significantly higher in non DIH group as compared to DIH group (89.3% vs. 61.1%, p =.006). Conclusion: Oxidative stress and ER stress are related with the severity of TBM, its outcome and mortality.