Influence of metabolic dysfunction-associated steatotic liver disease on antituberculosis drug-induced liver injury

The risk of antituberculosis drug-induced liver injury (AT-DILI) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is not clear. The aim of this study was to investigate incidence and risk factors associated with AT-DILI in MASLD patients. Retrospectively, a total of 120 MASLD patients who received antituberculosis medication from December 2017 to March 2023 were reviewed, including 91 males and 29 females. The participants were categorized into 2 cohorts based on the presence or absence of liver injury. Risk factors for AT-DILI were analyzed using logistic regression analysis. Among the 120 patients with treatment of tuberculosis complicated with MASLD, 28 (23.3%) patients developed AT-DILI. The remaining 92 (76.7%) patients did not develop AT-DILI. In the group of patients with liver injury, there were 26 cases of mild liver injury, one case of moderate liver injury, and one case of acute liver failure. Additionally, there were 23 cases of hepatocellular injury, 3 cases of cholestasis, and 2 cases of mixed liver injury. AT-DILI was observed during antituberculosis treatment 30.4 ± 17.6 days after the treatment began. There were significant differences in age, body mass index (BMI), platelet count, total bilirubin, fibrosis-4 (FIB-4) between the liver injury group, and the non-liver injury group (P < .05 in all). There were no significant differences in gender, hemoglobin, albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyltransferase, total cholesterol, triglyceride, combined hypertension, and combined diabetes mellitus between the liver injury group, and the non-liver injury group (P > .05 in all). By logistic regression analysis, low BMI and FIB-4 were a high-risk factor for liver injury. The incidence of AT-DILI was high in patients with pulmonary tuberculosis complicated with MASLD. Clinicians should focus on the risk of AT-DILI in patients with low BMI and elevated FIB-4 scores.