Abstract:

Objective: To analyze the status and related influencing factors of anti-tuberculosis drug-induced liver injury (ATB-DILI) in children. Methods: A retrospective study was conducted to enroll 200 hospitalized or outpatient children who were diagnosed with tuberculosis and met the enrollment criteria from June 2018 to June 2022 in the Changsha Central Hospital Affiliated Hospital, Hengyang Medical School, University of South China. All children used hepatoprotective drugs throug the full course. Among them, 52 patients developed ATB-DILI, with an incidence rate of 26.0%. We analyzed the clinical manifestations, severity, pathological damage, onset time, and related influencing factors of ATB-DILI in those children. Results: Among the 52 children who developed liver injury, 20 cases (38.5%) had no obvious symptoms but only abnormal liver function test results, 32 cases (61.5%) were anorexic, 29 cases (55.8%) vomited, and 3 cases (5.8%) showed jaundice, all patients were recovering with liver-protecting drugs and symptomatic treatment; 51 cases had grade 1 (mild) ATB-DILI, 1 case got grade 2 (moderate), and there were no patients with grade 3-5 liver injury. Liver injury type were hepatocellular injury for all patients. ATB-DILI occurred in 29 cases (55.8%) within 2 weeks after anti-tuberculosis treatment started, 8 cases (15.4%) within 3-8 weeks, 5 cases (9.6%) within 9-12 weeks, 7 cases (13.5%) within 13-16 weeks, and 3 cases (5.7%) within 16-24 weeks. Multifactorial logistic regression analysis showed that body mass index <18.5 (OR (95%CI)=2.340 (1.104-4.959)), serum pre-albumin <200 mg/L (OR (95%CI)=2.337 (1.093-4.997)) and hemoglobin <120 g/L (OR (95%CI)=2.403 (1.176-4.908)) were independent risk factors for the development of ATB-DILI in children with tuberculosis. Conclusion: The incidence of ATB-DILI in tuberculosis children who used hepatoprotective drugs through the full course of anti-tuberculosis treatment is still not low, but its clinical manifestations, severity, and pathological damage are significantly reduced. Clinicians should pay attention to the risk of ATB-DILI in pediatric patients with tuberculosis whose body mass index, serum prealbumin, and hemoglobin are below normal values within 2 weeks after anti-tuberculosis treatment initiated.

Key words: Child, Antitubercular agents, Drug-induced liver injury, Factor analysis, statistical