Background: Management of tuberculosis in decompensated cirrhosis is challenging, as the risk of severe liver failure is markedly increased if hepatotoxicity develops secondary to anti-tubercular treatment (ATT). Child-Turcotte-Pugh (CTP) score-based ATT by Dhiman et al. proposed that the number of hepatotoxic drugs should be two, one and none in CTP scores of ≤ 7, 8-10 and ≥ 11, respectively. We present here our retrospective observational study of treating tuberculosis in patients with decompensated cirrhosis utilizing the above-mentioned CTP-based ATT regimens.
Methods: A retrospective observational study utilizing electronic data search was conducted on the application-based software for the duration from April 2022 to April 2024. On the software, decompensated cirrhosis with tuberculosis patients were already tagged. The modified ATT regimens (weight-based) were as per the CTP score. With CTP score ≥ 11, no hepatotoxic drug was included: Intensive Phase -ELA (Ethambutol, Levofloxacin and Amikacin); Continuation Phase: EL. With CTP scores 8-10, 1 hepatotoxic drug (rifampicin preferred) was included; Intensive Phase: RELA, R Rifampicin; Continuation Phase: REL. CTP score ≤ 7 received two hepatotoxic drugs, Intensive Phase: HREL, H Isoniazid, Continuation Phase: HRE. The duration of ATT's continuation phase was 12-18 months.
Results: Of 155 patients with decompensated cirrhosis, 21 (13.5%) had concomitant tuberculosis. CTP score-based modified ATT was administered to all 21 during the Intensive phase. Drug-induced hepatotoxicity developed in four patients (19.1%) during the intensive phase. After the intensive phase, two patients were lost to follow-up. Out of 19 patients who completed the continuation phase, 15 (78.9%) had a resolution of tuberculosis and four (21.1%) died. The cause for death in all four patients was related to cirrhosis.
Conclusion: As per our study, patients with decompensated cirrhosis tolerated the CTP-score-based modified ATT and almost 80% had a resolution of tuberculosis.
Keywords: Child-Turcotte-Pugh score; Chronic liver disease; Modified Antitubercular therapy; North India; Private center; Tuberculosis.
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