Circulatory Inflammatory Mediators in the Prediction of Anti-Tuberculous Drug-Induced Liver Injury Using RUCAM for...

Area of Science:

• Hepatology
• Infectious Diseases
• Pharmacology

Background:

• Anti-tuberculous (TB) medications are a leading cause of drug-induced liver injury (DILI).
• Predictive biomarkers for TB-DILI are lacking, necessitating research into systemic inflammatory mediators.
• Early identification of patients at risk for DILI is critical for treatment management.

Purpose of the Study:

• To identify pre-treatment systemic inflammatory mediators that predict DILI in TB patients.
• To develop a predictive model for DILI risk in individuals undergoing anti-TB therapy.

Main Methods:

• A prospective cohort of adult active TB patients receiving standard anti-TB treatment was enrolled.
• DILI was defined by elevated liver enzymes (ALT ≥5× ULN) or bilirubin (≥2.6× ULN) with causality assessment.
• Pre-treatment plasma samples were analyzed for 15 candidate biomarkers, and Cox regression was used for model development.

Main Results:

• 19 out of 240 (7.9%) patients developed DILI.
• Interleukin-22 binding protein (IL-22BP), interferon gamma-induced protein 1 (IP-10), and soluble CD163 (sCD163) were significant predictors.
• A predictive score incorporating IL-22BP, IP-10, and sCD163 achieved an area under the curve of 0.744 (p < 0.001).

Conclusions:

• Pre-treatment IL-22BP acts as a protective biomarker against DILI during TB treatment.
• A predictive score combining IL-22BP, IP-10, and sCD163 offers adequate prediction of DILI risk.