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A comparison between two strategies for monitoring hepatic function during antituberculous therapy.

Singanayagam, A; Sridhar, S; Dhariwal, J; Abdel-Aziz, D; Munro, K; Connell, DW; George, PM; (2012) A comparison between two strategies for monitoring hepatic function during antituberculous therapy. Am J Respir Crit Care Med , 185 (6) pp. 653-659. 10.1164/rccm.201105-0850OC.

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Abstract

RATIONALE: The optimum strategy for monitoring liver function during antituberculous therapy is unclear. OBJECTIVES: To assess the value of the American Thoracic Society risk-factor approach for predicting drug-induced liver injury and to compare with a uniform policy of liver function testing in all patients at 2 weeks. METHODS: We conducted an observational study of adult patients undergoing therapy for active tuberculosis at a tertiary center. All patients had alanine transferase measurement at baseline and 2 weeks following commencement of therapy. Sensitivity, specificity, and positive and negative predictive values were used to assess strategies. MEASUREMENTS AND MAIN RESULTS: There were 288 patients included, and 21 (7.3%) developed drug-induced liver injury (57.1% "early" at 2 wk and 42.9% "late," after 2 wk). There were increased rates of individuals with HIV infection in the early drug-induced liver injury group compared with no drug-induced liver injury and late drug-induced liver injury groups (33% vs. 7.1% vs. 0%; P = 0.004). The American Thoracic Society algorithm had a sensitivity and specificity of 66.7 and 65.6%, respectively, for prediction of early and 22.2% and 63.7% for late drug-induced liver injury. The uniform monitoring policy had poor sensitivity but better specificity (22.2 and 82.1%) for prediction of late drug-induced liver injury. CONCLUSIONS: In our urban, ethnically diverse population, a risk-factor approach is neither sensitive nor specific for prediction of drug-induced liver injury. A uniform policy of liver function testing at 2 weeks is useful for prompt identification of a subgroup who develop early drug-induced liver injury and may offer better specificity in ruling out late drug-induced liver injury.

Type: Article
Title: A comparison between two strategies for monitoring hepatic function during antituberculous therapy.
Location: United States
DOI: 10.1164/rccm.201105-0850OC
Keywords: Adult, Alanine Transaminase, Antitubercular Agents, Drug-Induced Liver Injury, Female, Follow-Up Studies, Humans, Liver Function Tests, Male, Middle Aged, Monitoring, Physiologic, Practice Guidelines as Topic, Predictive Value of Tests, Prospective Studies, ROC Curve, Risk Factors, Tuberculosis
UCL classification: UCL > School of Life and Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Medicine (Division of)
URI: http://discovery.ucl.ac.uk/id/eprint/1344921
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