Patients with tuberculous meningitis and hepatitis B co-infection have increased risk for antituberculosis drug-induced liver injury and poor outcomes

Abstract

Background

Tuberculous meningitis (TBM) is one of the most severe forms of tuberculosis. Previous studies reported that hepatitis B virus (HBV) infection could increase the risk of antituberculosis drug-induced liver injury (ATB-DILI) in pulmonary tuberculosis patients. To date, only a few studies exist on the effect of HBV on TBM.

Methods

This inpatient study retrospectively analyzed the medical records of patients who were diagnosed with TBM between June 2002 and June 2018. Statistical analysis was used to reveal the difference between the HBV and non-HBV groups. Univariate analysis and multivariate regression analysis were performed on data to determine the prognostic factors of TBM.

Results

A total of 386 patients were enrolled in our study, 57 of whom were included in the HBV group and 329 in the non-HBV group. The HBV group showed a higher frequency of ATB-DILI (HBV group: 14.0% versus non-HBV group: 3.3%, p < .001) and a higher risk of poor outcomes (i.e. death during inpatient period or neurological deficit at discharge, HBV group: 31.6% versus non-HBV group: 19.8%, p = .045) than the non-HBV group. The multivariate regression analysis identified ATB-DILI, scores of 3–8 on the Glasgow Coma Scale and hydrocephalus as independent predictors of poor outcomes in TBM patients.

Conclusions

Our study demonstrated that HBV co-infection could increase the incidence of ATB-DILI and the risk of poor outcomes as identified by three predictors in TBM patients.

Keywords:

• Tuberculous meningitis
• hepatitis B virus
• antituberculosis drug-induced liver injury
• predictors

Ethics approval

The study was approved by the clinical research ethics committee of Nanfang Hospital of Southern Medical University. This was a retrospective study that did not need informed consent, whereas it was consistent with the principles of the Helsinki declaration.

Disclosure statement

The authors declare that they have no conflict of interest.

Additional information

Funding

This study was supported by grants from the National Science Foundation of China [No. 81971949], National Science and Technology Key Project on ‘Major Infectious Diseases such as HIV/AIDS, Viral Hepatitis Prevention and Treatment’ [Nos. 2017ZX09304016 and 2017ZX10302201004008] and Clinical Research Start-up Programme of Southern Medical University by High-level University Construction Funding of Guangdong Provincial Department of Education [No. LC2016PY003]. The funding sources did not have any influence on the study design, data collection, analysis and interpretation of the data, writing of the report, or the decision to submit for publication.