Predicting drug-induced liver injury from anti-tuberculous medications by early monitoring of liver tests

Benjamin Patterson*, Aula Abbara, Simon Collin, Merle Henderson, Monicka Shehata, Hannah Gorgui-Naguib, William Lynn, Onn Min Kon, Laurence John

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)
45 Downloads (Pure)


OBJECTIVE: Tuberculosis Drug Induced Liver Injury (TB-DILI) is a common and potentially severe complication associated with anti-tuberculous treatment (ATT). Optimal liver test monitoring for standard TB medication has not been established. We describe the predictive value of pre-treatment liver tests (LTs) and at 2-weeks after initiation of ATT for the detection of TB-DILI.

METHODS: Patients initiating ATT were monitored with routine LTs pre-treatment and after 2-weeks. Logistic regression models were constructed to retrospectively identify pre-treatment variables associated with 'late' TB-DILI (>2 weeks after treatment initiation) and whether pre-treatment and 2-week alanine aminotransferase (ALT) levels could predict late TB-DILI.

RESULTS: 1247 patients with active tuberculosis managed at 5 sites across north west London between January 2015 and December 2018 were monitored with routine LTs. 103 cases (8.3%) of ATT-associated DILI were diagnosed. 60 cases (58.3%) of TB-DILI occurred later than 2-weeks. The risk of late TB-DILI was 2.2-fold greater for every 30 U/L increment in ALT pre-treatment (OR 2.16, 95% CI 1.38-3.29 p<0.001) and 2.1-fold greater for every 30 U/L increment in ALT gradient at 2-weeks (OR 2.06, 95% CI 1.52-2.76 p<0.001).

CONCLUSION: Routine 2-week LTs capture early TB-DILI and may be valuable in predicting late TB-DILI in patients on ATT.

Original languageEnglish
Pages (from-to)240-244
Number of pages5
JournalJournal of Infection
Issue number2
Early online date30 Nov 2020
Publication statusPublished - 1 Feb 2021

Bibliographical note

Publisher Copyright:
© 2020 The British Infection Association


  • Antitubercular Agents/adverse effects
  • Chemical and Drug Induced Liver Injury/diagnosis
  • Humans
  • London
  • Retrospective Studies
  • Tuberculosis/diagnosis


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