Although antituberculosis therapy (ATT)–associated acute liver failure (ATT-ALF) is the most frequent drug-induced ALF in South Asia, prospective studies on ATT-ALF are scarce. The authors of the current study determined the magnitude, clinical course, outcome, and prognostic factors in ATT-ALF. 

The study included 1223 consecutive ALF patients from January 1986 to January 2009. They found that ATT alone was the cause in 70 (5.7%) patients while 15 (1.2%) had ATT and simultaneous hepatitis virus infection. Moreover, ATT was prescribed in 44 (62.8%) patients empirically without conclusive evidence of tuberculosis. The included patients of ATT-ALF were younger (32.87 [615.8] years), and 70% of them were women. Most of the patients had hyperacute presentation and the median icterus encephalopathy interval was 4.5 (0-30) days. The median duration of ATT before ALF was 30 (7-350) days. 

The outcome revealed that, advanced encephalopathy and cerebral edema were present in 51 (76%) and 29 (41.4%) patients, respectively at the time of enrolment of the study. The incidence of gastrointestinal bleed, seizures, infection, and acute renal failure were reported in seven (10%), five (7.1%), 26 (37.1%), and seven (10%) patients, respectively. All of the recruited ATT-ALF patients had nearly comparable presentations except for older age and less elevated liver enzymes in contrast to hepatitis E virus (HEV) and non-A non-E–induced ALF. The mortality rate among patients with ATT-ALF was high (67.1%, n 5 47), and only 32.9% patients got resolution with help of medical treatment. At presentation, three factors including serum bilirubin (‡10.8 mg/dL), prothrombin time (PT) prolongation (‡26 seconds), and grade III/IV encephalopathy were considered as independent prediction of mortality. 

Based on the observations, it was concluded that ATT-ALF was composed of 5.7% of ALF and exhibited a high mortality rate. However, due to high rate of mortality rate, evaluation of predicting risk factors became insignificant. Moreover, the results also divulged that consumption of empirical ATT in majority of patients could be avoided due to high death rate.

Source: Kumar R; Shalimar, Bhatia V, Khanal S, Sreenivas V, Gupta SD, Panda SK, Acharya SK. Antituberculosis therapy-induced acute liver failure: magnitude, profile, prognosis, and predictors of outcome. Hepatology. 2010 May;51(5):1665-74.