Alanine transaminase and hemoglobin appear to predict the occurrence of antituberculosis medication hepatotoxicity; findings and implications in Botswana

Abstract

Objective: Tuberculosis (TB) remains a global health problem, with medications having adverse effects including drug-induced hepatotoxicity. We determined the prevalence of anti-tuberculosis druginduced hepatotoxicity and associated risk factors. Methods: Retrospective cross-sectional study in Botswana including TB patients admitted from 1 June 2017 to 30 June 2018. Anti-TB drug-induced hepatotoxicity was categorized according to WHO criteria whereas causality assessment was made according to the updated Roussel Uclaf Causality Assessment Method (RUCAM) scale. The association between hepatotoxicity and included variables was undertaken by binary logistic regression. Results: Out of 112 patient files, 15 (13.4%) developed hepatotoxicity after an average of 20.4 days from the start of treatment. Grade 3 and 4 hepatotoxicity was found in 66.7% of the cases. According to the updated RUCAM tool, 86.7% of patients were categorized as having possible anti-TB-associated hepatotoxicity. Patients with elevated baseline alanine transaminase (ALT) were more likely to develop hepatotoxicity (OR = 3.484, 95% CI = 1.02-11.90). Patients with normal hemoglobin (Hb ≥ 12 g/dl) were also more likely to develop hepatotoxicity (OR = 4.413, 95% CI = 1.160-14.8). Conclusion: Overall, normal hemoglobin and elevated baseline ALT levels were significantly associated with anti-TB drug-induced hepatotoxicity. Additional research is needed to explore this association further.

An easy-to-use Nomogram for Predicting Antituberculosis Drug- Induced Hepatotoxicity in Hospitalized Patients

“…We also compared baseline ALT and hemoglobin levels in both the ATDH and non-ATDH groups and showed no statistical difference between the two groups. The previous study has shown a signi cant correlation between baseline ALT levels and ATDH [30]. In their study, normal baseline levels of hemoglobin were also signi cantly correlated with ATDH.…”

Xiao-Yao-San protects against anti-tuberculosis drug-induced liver injury by regulating Grsf1 in the mitochondrial oxidative stress pathway

“…China is the third largest source of new TB cases globally, and it accounts for 8.4% of the global total ( WHO, 2020 ). However, most of the first-line drugs used to treat TB have potential hepatotoxic effects ( Kesenogile et al, 2021 ). Drug-induced Liver Injury (DILI) is an injury to the liver or biliary system associated with the ingestion of hepatotoxic drugs, and it is one of the most common causes of acute liver failure ( Devarbhavi et al, 2018 ).…”