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69 LIVER FUNCTION TEST ABNORMALITIES IN TUBERCULOSIS PATIENTS ON REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAM (RNTCP)
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
69 LIVER FUNCTION TEST ABNORMALITIES IN TUBERCULOSIS PATIENTS ON REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAM (RNTCP) L Thayumanavan, T Kingsley, R Rathinam, K Mariappan Department of Gastroenterology, Madurai Medical College, Madurai Background: Abnormal liver function tests (LFT) are observed in 3–15% of tuberculosis (TB) patients as anti-tuberculous treatment (ATT). We studied the LFT abnormalities in TB patients in the Revised National Tuberculosis Control Program (RNTCP) Dots regimens. Aim: (i) To document LFT abnormalities in patients undergoing ATT, (ii) to compare LFT abnormalities in the 3 regimens of RNTCP, and (iii) to evaluate risk factors to predict hepatotoxicity. Method: Patients on ATT in TB Clinic between June 2007 and June 2008 were included. Those who had, chronic liver disease, abnormal LFTs at base line, alcoholism and previous hepatotoxicity were excluded. Detailed history, examination, BI, CBC, and LFTs were done at baseline 2 weeks, 4 weeks, and 24 weeks. USGM and HIV Screening were done. RNTCP category I included 2 (HRZE)3 + 4 (H0)3, category II was 2 (HRZES)3 + 1 + (HRZE) + 1 (HRZ), category III 2 (HRZ)3 + 4 (HR)5. Result: Of 166 patients, 156 completed follow-up of 24 weeks, and mean age was 36.6 years (15–78 years) with 88 males and 68 females. Ninety patients were diagnosed with pulmonary tuberculosis (PT), 30 effusions, 13 nodal, 4 abdominal TB, 2 skeletal TB 13 and 9 neuro TB. Ninety patients were on category I, 52 patients on category II and
14 patients on category III. Sputum was positive in 55% of patients. Body mass index (BMI) was < 18.5 in 35 patients. 24/156 had abnormal LFTs; asymptomatic rise of ALT was in 16, acute hepatitis in 8, LFT derangements occurred within 2 weeks. The pattern of hepatotoxicity occurred more in 40–49 age groups. Hepatotoxicity was seen in 42.9% of category II, 14.4% in category I and 9.6 in category III, sputum positive 22%, anemia 34.7%, low BMI 54.3%, hypoalbuminemia 45.9%, and HIV status 50% had more hepatotoxicity. Conclusion: (i) Liver function abnormalities were seen in 15.6% more in category II, (ii) asymptomatic elevation of transaminases was the most common abnormalities, and (iii) direct correlation was seen with BMI, anemia and hypoalbuminemia, and sputum positivity was noted.
70 THIRTY-YEAR AUDIT OF PERCUTANEOUS LIVER BIOPSY IN A TERTIARY CARE CENTER G Ayyappan, G Sarin, V Thomas Department of Gastroenterology, Government Medical College, Calicut, Kerala Background: Liver biopsy is the gold standard for the assessment of liver pathology but carries certain risks. Aim: To study the indications, safety, and outcome of liver biopsy in a tertiary care center over three decades. Method: Medical records of all patients who had undergone liver biopsy between January 1981 and December 2011 in our institution were reviewed retrospectively. The needles used were Menghini (1981 to 1996), Trucut (1997–2004) and Bard biopsy gun (2005–2011). The rate of complications with different needles and between different operators according to their experience was compared. Result: One thousand and one hundred ninety-seven percutaneous liver biopsies (males 895–74.7%, M:F 2.9); mean age 45.2 (range 14–82 years) were performed during the study period (performed by residents 835, consultants 362). The major indications were hepatitis B virus (HBV) infection 349 (29.1%), cirrhosis 174 (14.5%), hepatitis C virus (HCV) infection 158 (13.2%), suspected neoplasm-141 (11.8%), abnormal liver function test (LFT) 127 (10.6%) and unexplained hepatomegaly 94 (7.9%). There were eight major complications (0.67%); hemorrhage 4, bile leak 1, pleural effusion 2, hemoptysis 1. There were three deaths (0.25%); all were due to hemorrhage, but none had abnormal coagulation profile. Minor complications occurred in 178 (14.87; pain (93–7.76%), obtaining non-diagnostic tissue (61–5.09%), vasovagal episodes (13–1.09%) and vomiting (11–0.92%). There was no significant difference in major or minor complication rates between the procedures done by consultants and residents. The number of procedures using different needles was Menghini 548, Trucut 302 and Bard biopsy Gun 347. Major complications occurred
Journal of Clinical and Experimental Hepatology | March 2012 | Vol. 2 | Suppl 1 | S6–S39
S37
Abstracts
12 of 48 (25%) GSTT1, and 21 of 48 (43.7%) showed GSTT1/GSTM1/β-globulin. While 39 of 252 (15.5%) showed GSTM1, 84 of 252 (33.3%) GSTT1, and 129 of 252 (51.2%) showed GSTT1/M1/ß-globulin in nonhepatotoxicity patients. On the basis of NAT-2 polymorphisms, 18/48 (37.5%) were slow acetylators, while in non-hepatotoxicity group, 37/252 (14.7%) were slow acetylators. NAT-2 gene alleles 4/6, 5/5, 6/6, and 7/7 were not present in hepatotoxicity patients, but these were present in non-hepatotoxicity group. However, 5/6 and 6/7 were significantly higher in hepatotoxicity patients. CYP2E1 gene alleles i.e. c1/c1, c2/c2, and c1/c2 were 61.1%, 16.6%, and 22.2% in non-hepatotoxicity group, respectively, while 50%, 25%, and 25%, respectively in hepatotoxicity group. Conclusion: This study indicates that GSTM1 and slow acetylators on the basis of NAT-2 gene polymorphisms were significantly higher in hepatotoxicity patients as compared to non-hepatotoxicity patients. However, there was no significant association between CYP2E1 alleles and development of hepatotoxicity.
69 LIVER FUNCTION TEST ABNORMALITIES IN TUBERCULOSIS PATIENTS ON REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAM (RNTCP) L Thayumanavan, T Kingsley, R Rathinam, K Mariappan Department of Gastroenterology, Madurai Medical College, Madurai Background: Abnormal liver function tests (LFT) are observed in 3–15% of tuberculosis (TB) patients as anti-tuberculous treatment (ATT). We studied the LFT abnormalities in TB patients in the Revised National Tuberculosis Control Program (RNTCP) Dots regimens. Aim: (i) To document LFT abnormalities in patients undergoing ATT, (ii) to compare LFT abnormalities in the 3 regimens of RNTCP, and (iii) to evaluate risk factors to predict hepatotoxicity. Method: Patients on ATT in TB Clinic between June 2007 and June 2008 were included. Those who had, chronic liver disease, abnormal LFTs at base line, alcoholism and previous hepatotoxicity were excluded. Detailed history, examination, BI, CBC, and LFTs were done at baseline 2 weeks, 4 weeks, and 24 weeks. USGM and HIV Screening were done. RNTCP category I included 2 (HRZE)3 + 4 (H0)3, category II was 2 (HRZES)3 + 1 + (HRZE) + 1 (HRZ), category III 2 (HRZ)3 + 4 (HR)5. Result: Of 166 patients, 156 completed follow-up of 24 weeks, and mean age was 36.6 years (15–78 years) with 88 males and 68 females. Ninety patients were diagnosed with pulmonary tuberculosis (PT), 30 effusions, 13 nodal, 4 abdominal TB, 2 skeletal TB 13 and 9 neuro TB. Ninety patients were on category I, 52 patients on category II and
14 patients on category III. Sputum was positive in 55% of patients. Body mass index (BMI) was < 18.5 in 35 patients. 24/156 had abnormal LFTs; asymptomatic rise of ALT was in 16, acute hepatitis in 8, LFT derangements occurred within 2 weeks. The pattern of hepatotoxicity occurred more in 40–49 age groups. Hepatotoxicity was seen in 42.9% of category II, 14.4% in category I and 9.6 in category III, sputum positive 22%, anemia 34.7%, low BMI 54.3%, hypoalbuminemia 45.9%, and HIV status 50% had more hepatotoxicity. Conclusion: (i) Liver function abnormalities were seen in 15.6% more in category II, (ii) asymptomatic elevation of transaminases was the most common abnormalities, and (iii) direct correlation was seen with BMI, anemia and hypoalbuminemia, and sputum positivity was noted.
70 THIRTY-YEAR AUDIT OF PERCUTANEOUS LIVER BIOPSY IN A TERTIARY CARE CENTER G Ayyappan, G Sarin, V Thomas Department of Gastroenterology, Government Medical College, Calicut, Kerala Background: Liver biopsy is the gold standard for the assessment of liver pathology but carries certain risks. Aim: To study the indications, safety, and outcome of liver biopsy in a tertiary care center over three decades. Method: Medical records of all patients who had undergone liver biopsy between January 1981 and December 2011 in our institution were reviewed retrospectively. The needles used were Menghini (1981 to 1996), Trucut (1997–2004) and Bard biopsy gun (2005–2011). The rate of complications with different needles and between different operators according to their experience was compared. Result: One thousand and one hundred ninety-seven percutaneous liver biopsies (males 895–74.7%, M:F 2.9); mean age 45.2 (range 14–82 years) were performed during the study period (performed by residents 835, consultants 362). The major indications were hepatitis B virus (HBV) infection 349 (29.1%), cirrhosis 174 (14.5%), hepatitis C virus (HCV) infection 158 (13.2%), suspected neoplasm-141 (11.8%), abnormal liver function test (LFT) 127 (10.6%) and unexplained hepatomegaly 94 (7.9%). There were eight major complications (0.67%); hemorrhage 4, bile leak 1, pleural effusion 2, hemoptysis 1. There were three deaths (0.25%); all were due to hemorrhage, but none had abnormal coagulation profile. Minor complications occurred in 178 (14.87; pain (93–7.76%), obtaining non-diagnostic tissue (61–5.09%), vasovagal episodes (13–1.09%) and vomiting (11–0.92%). There was no significant difference in major or minor complication rates between the procedures done by consultants and residents. The number of procedures using different needles was Menghini 548, Trucut 302 and Bard biopsy Gun 347. Major complications occurred
Journal of Clinical and Experimental Hepatology | March 2012 | Vol. 2 | Suppl 1 | S6–S39
S37
Abstracts
12 of 48 (25%) GSTT1, and 21 of 48 (43.7%) showed GSTT1/GSTM1/β-globulin. While 39 of 252 (15.5%) showed GSTM1, 84 of 252 (33.3%) GSTT1, and 129 of 252 (51.2%) showed GSTT1/M1/ß-globulin in nonhepatotoxicity patients. On the basis of NAT-2 polymorphisms, 18/48 (37.5%) were slow acetylators, while in non-hepatotoxicity group, 37/252 (14.7%) were slow acetylators. NAT-2 gene alleles 4/6, 5/5, 6/6, and 7/7 were not present in hepatotoxicity patients, but these were present in non-hepatotoxicity group. However, 5/6 and 6/7 were significantly higher in hepatotoxicity patients. CYP2E1 gene alleles i.e. c1/c1, c2/c2, and c1/c2 were 61.1%, 16.6%, and 22.2% in non-hepatotoxicity group, respectively, while 50%, 25%, and 25%, respectively in hepatotoxicity group. Conclusion: This study indicates that GSTM1 and slow acetylators on the basis of NAT-2 gene polymorphisms were significantly higher in hepatotoxicity patients as compared to non-hepatotoxicity patients. However, there was no significant association between CYP2E1 alleles and development of hepatotoxicity.