Incidence, outcomes, and risk factors of antituberculosis drugs induced liver injury in Thailand: A retrospective cohort study

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Pattaraporn Akkahadsee
Sirot Jantharaksa
Ratree Sawangjit
Panumart Phumart


tuberculosis, drug-induced liver injury, hepatotoxicity, risk factors


Background: Tuberculosis (TB) is a persistent health concern in numerous regions, including Thailand. The adverse effects of tuberculosis (TB) treatments, particularly liver injuries, can complicate treatment protocols, thereby increasing the likelihood of treatment discontinuation and the risk of subsequent drug resistance. Objective: This study was conducted to investigate the incidence, predisposing factors, and treatment outcomes associated with antituberculosis drugs induced liver injury (ATDILI) in Northeastern Thailand. Methods: A retrospective analysis was conducted at Mahasarakham Hospital in 2019. Patient data were retrieved from hospital records and databases. Inclusion criteria included receiving a first-time TB diagnosis, starting a standard TB regimen, and having normal liver function. To compare baseline characteristics between ATDILI patients and controls, Chi-square tests and T-tests were used. Bivariate and multivariable regression analyses were conducted to identify factors associated with drug-induced hepatitis. Results: 346 of 602 TB patients (57.5%) were enrolled. The study found an incidence of ATDILI at 14.45% (50 cases), which is notably higher than the Thai average of 4.8%. Risk factors were identified as malnutrition (adjusted OR=6.71, 95%CI 3.11:14.45), concurrent diseases (adjusted OR=2.42, 95%CI 1.20:4.89), and alcohol consumption (adjusted OR=4.24, 95%CI 1.45:12.38). In terms of therapeutic outcomes, only 18 patients were cured (36.0%). The probability of hepatotoxic events was addressed during the initial treatment phase, emphasizing the critical need for rigorous liver function monitoring during the first month of TB therapy. The ATDILI group had a mortality rate of 16%, which was higher than the national TB-related average of 8.2%. Conclusion: The marked presence of ATDILI in the cohort under study accentuates the immediate need for enhanced clinical monitoring, especially among susceptible groups. It is imperative to implement strategies aimed at early detection, prompt intervention, and holistic management of ATDILI, complemented by endeavors to boost cure rates for the affected population.

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