Antituberculosis Therapy-Induced Acute Liver Failure: Magnitude, Profile, Prognosis, and Predictors of Outcome

被引:127
作者
Kumar, Ramesh [1 ]
Shalimar [1 ]
Bhatia, Vikram [1 ]
Khanal, Shankar [2 ]
Sreenivas, V. [2 ]
Gupta, S. Datta [3 ]
Panda, Subrat K. [3 ]
Acharya, Subrat K. [1 ]
机构
[1] All India Inst Med Sci, Dept Gastroenterol, New Delhi 110029, India
[2] All India Inst Med Sci, Dept Biostat, New Delhi 110029, India
[3] All India Inst Med Sci, Dept Pathol, New Delhi 110029, India
关键词
HEPATITIS-E VIRUS; DRUG-INDUCED HEPATOTOXICITY; FULMINANT-HEPATITIS; CLINICAL-COURSE; UNITED-STATES; TUBERCULOSIS; TRANSPLANTATION; INFECTION; PREGNANCY;
D O I
10.1002/hep.23534
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Antituberculosis therapy (ATT) associated acute liver failure (ATT-ALF) is the commonest drug-induced ALF in South Asia. Prospective studies on ATT-ALF are lacking. The current study prospectively evaluated the magnitude, clinical course, outcome, and prognostic factors in ATT-ALF. From January 1986 to January 2009, 1223 consecutive ALF patients were evaluated: ATT alone was the cause in 70 (5.7%) patients. Another 15 (1.2%) had ATT and simultaneous hepatitis virus infection. In 44 (62.8%) patients, ATT was prescribed empirically without definitive evidence of tuberculosis. ATT-ALF patients were younger (32.87 [+/- 15.8] years), and 49 (70%) of them were women. Most had hyperacute presentation; the median icterus encephalopathy interval was 4.5 (0-30) days. The median duration of ATT before ALF was 30 (7-350) days. At presentation, advanced encephalopathy and cerebral edema were present in 51 (76%) and 29 (41.4%) patients, respectively. Gastrointestinal bleed, seizures, infection, and acute renal failure were documented in seven (10%), five (7.1%), 26 (37.1%), and seven (10%) patients, respectively. Compared with hepatitis E virus (HEY) and non-A non-E induced ALF, ATT-ALF patients had nearly similar presentations except for older age and less elevation of liver enzymes. The mortality rate among patients with ATT-ALF was high (67.1%, n = 47), and only 23 (32.9%) patients recovered with medical treatment. In multivariate analysis, three factors independently predicted mortality: serum bilirubin (>= 10.8 mg/dL), prothrombin time (PT) prolongation (26 seconds), and grade III/IV encephalopathy at presentation. Conclusion: ATT-ALF constituted 5.7% of ALF at our center and had a high mortality rate. Because the mortality rate is so high, determining which factors are predictors is less important. A high proportion of patients had consumed ATT empirically, which could have been prevented. (HEPATOLOGY 2010;51:1665-1674)
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页码:1665 / 1674
页数:10
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