Insiden dan Faktor Risiko Terjadinya Hepatotoksisitas yang Diinduksi Obat Anti Tuberkulosis pada Pasien Tuberkulosis Anak dalam Fase Intensif

Fajri, Gafar (2016) Insiden dan Faktor Risiko Terjadinya Hepatotoksisitas yang Diinduksi Obat Anti Tuberkulosis pada Pasien Tuberkulosis Anak dalam Fase Intensif. Masters thesis, Universitas Andalas.

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Abstract

Background: Data on antituberculosis drug-induced hepatotoxicity (ATDH) in Indonesian pediatric population are limited, probably because of liver function tests are not monitored routinely during tuberculosis treatment. Objective: To determine the incidence and risk factors of ATDH in children during the intensive phase of tuberculosis treatment. Methods: We performed a prospective observational study in M. Djamil Hospital, Padang, Indonesia from September 2015 to April 2016. Liver function tests were performed at baseline, after 2 weeks, and subsequently after 4, 6 and 8 weeks if the initial 2-week measurement was abnormal. Result: Among 41 patients, ATDH was detected in 11 (26.8%) patients within 14-42 days (mean ± SD: 22.9 ± 11.3 days) from the start of therapy. On bivariate analysis, patients with ATDH significantly associated with extra-pulmonary tuberculosis (P=0.038; OR: 5.89; 95% CI: 1.08-32.01), hypoalbuminemia (P=0.029; OR: 6.22; 95% CI: 1.33-29.01), concomitant hepatotoxic drugs (P=0.001; OR: 20.00; 95% CI: 2.24-178.94), and HRZE (isoniazid, rifampicin, pyrazinamide and ethambutol) drugs regimen (P=0.012; OR: 9.00; 95% CI: 1.63-49.76), but did not significantly associated with age, gender, nutritional status, abnormalities of baseline liver function tests and HIV status. Multivariate logistic regression analysis showed patients with hipoalbuminemia (P=0.049; OR: 0.16; 95% CI: 0.03-0.99) and concomitant hepatotoxic drugs (P=0.036; OR: 0.06; 95% CI: 0.01-0.84) were identified as predominant risk factors. Conclusion: The incidence of ATDH was 26.8% of total patients during the intensive phase of tuberculosis treatment. Patients with hypoalbuminemia and concomitant hepatotoxic drugs were the predominant risk factors of ATDH. Key words: antituberculosis drug, hepatotoxicity, pediatric, risk factors.

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