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Influence of metabolic dysfunction-associated steatotic liver disease on antituberculosis drug-induced liver injury
1Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.
Abstract:
The risk of antituberculosis drug-induced liver injury (AT-DILI) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is not clear. The aim of this study was to investigate incidence and risk factors associated with AT-DILI in MASLD patients. Retrospectively, a total of 120 MASLD patients who received antituberculosis medication from December 2017 to March 2023 were reviewed, including 91 males and 29 females. The participants were categorized into 2 cohorts based on the presence or absence of liver injury. Risk factors for AT-DILI were analyzed using logistic regression analysis. Among the 120 patients with treatment of tuberculosis complicated with MASLD, 28 (23.3%) patients developed AT-DILI. The remaining 92 (76.7%) patients did not develop AT-DILI. In the group of patients with liver injury, there were 26 cases of mild liver injury, one case of moderate liver injury, and one case of acute liver failure. Additionally, there were 23 cases of hepatocellular injury, 3 cases of cholestasis, and 2 cases of mixed liver injury. AT-DILI was observed during antituberculosis treatment 30.4 ± 17.6 days after the treatment began. There were significant differences in age, body mass index (BMI), platelet count, total bilirubin, fibrosis-4 (FIB-4) between the liver injury group, and the non-liver injury group (P < .05 in all). There were no significant differences in gender, hemoglobin, albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyltransferase, total cholesterol, triglyceride, combined hypertension, and combined diabetes mellitus between the liver injury group, and the non-liver injury group (P > .05 in all). By logistic regression analysis, low BMI and FIB-4 were a high-risk factor for liver injury. The incidence of AT-DILI was high in patients with pulmonary tuberculosis complicated with MASLD. Clinicians should focus on the risk of AT-DILI in patients with low BMI and elevated FIB-4 scores.
Insights
Antituberculosis drug-induced liver injury (AT-DILI) occurred in 23.3% of patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Low body mass index (BMI) and high Fibrosis-4 (FIB-4) scores are significant risk factors for AT-DILI in this population.
Area of Science:
- Hepatology
- Pharmacology
- Infectious Diseases
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent.
- Antituberculosis drugs are essential but can cause liver injury.
- The specific risk of drug-induced liver injury in MASLD patients undergoing tuberculosis treatment is not well understood.
Purpose of the Study:
- To determine the incidence of antituberculosis drug-induced liver injury (AT-DILI) in patients with MASLD.
- To identify risk factors associated with AT-DILI in this patient cohort.
Main Methods:
- A retrospective review of 120 MASLD patients treated for tuberculosis between December 2017 and March 2023.
- Patients were divided into AT-DILI and non-AT-DILI groups.
- Logistic regression analysis was used to identify risk factors.
Main Results:
- The incidence of AT-DILI was 23.3% (28/120 patients).
- Liver injury ranged from mild to acute liver failure, with hepatocellular injury being most common.
- Significant risk factors identified were low body mass index (BMI) and high Fibrosis-4 (FIB-4) scores.
Conclusions:
- The incidence of AT-DILI is substantial in MASLD patients treated for tuberculosis.
- Low BMI and elevated FIB-4 scores are key indicators for increased AT-DILI risk.
- Clinicians should closely monitor MASLD patients with these risk factors during tuberculosis treatment.
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