Imperial College London
Alternate

Dr Melissa Wickremasinghe

Faculty of Medicine, National Heart & Lung Institute

Honorary Clinical Senior Lecturer
 
 
 
//

Contact

 

melissa.wickremasinghe

 
 
//

Location

 

Praed StreetSt Mary's Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Singanayagam:2012:10.1164/rccm.201105-0850OC,
author = {Singanayagam, A and Sridhar, S and Dhariwal, J and Abdel-Aziz, D and Munro, K and Connell, DW and George, PM and Molyneaux, PL and Cooke, GS and Burroughs, AK and Lalvani, A and Wickremasinghe, M and Kon, OM},
doi = {10.1164/rccm.201105-0850OC},
journal = {Am J Respir Crit Care Med},
pages = {653--659},
title = {A comparison between two strategies for monitoring hepatic function during antituberculous therapy},
url = {http://dx.doi.org/10.1164/rccm.201105-0850OC},
volume = {185},
year = {2012}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - RATIONALE: The optimum strategy for monitoring liver function during antituberculous therapy is unclear. OBJECTIVES: To assess the value of the American Thoracic Society risk-factor approach for predicting drug-induced liver injury and to compare with a uniform policy of liver function testing in all patients at 2 weeks. METHODS: We conducted an observational study of adult patients undergoing therapy for active tuberculosis at a tertiary center. All patients had alanine transferase measurement at baseline and 2 weeks following commencement of therapy. Sensitivity, specificity, and positive and negative predictive values were used to assess strategies. MEASUREMENTS AND MAIN RESULTS: There were 288 patients included, and 21 (7.3%) developed drug-induced liver injury (57.1% "early" at 2 wk and 42.9% "late," after 2 wk). There were increased rates of individuals with HIV infection in the early drug-induced liver injury group compared with no drug-induced liver injury and late drug-induced liver injury groups (33% vs. 7.1% vs. 0%; P = 0.004). The American Thoracic Society algorithm had a sensitivity and specificity of 66.7 and 65.6%, respectively, for prediction of early and 22.2% and 63.7% for late drug-induced liver injury. The uniform monitoring policy had poor sensitivity but better specificity (22.2 and 82.1%) for prediction of late drug-induced liver injury. CONCLUSIONS: In our urban, ethnically diverse population, a risk-factor approach is neither sensitive nor specific for prediction of drug-induced liver injury. A uniform policy of liver function testing at 2 weeks is useful for prompt identification of a subgroup who develop early drug-induced liver injury and may offer better specificity in ruling out late drug-induced liver injury.
AU  - Singanayagam,A
AU  - Sridhar,S
AU  - Dhariwal,J
AU  - Abdel-Aziz,D
AU  - Munro,K
AU  - Connell,DW
AU  - George,PM
AU  - Molyneaux,PL
AU  - Cooke,GS
AU  - Burroughs,AK
AU  - Lalvani,A
AU  - Wickremasinghe,M
AU  - Kon,OM
DO  - 10.1164/rccm.201105-0850OC
EP  - 659
PY  - 2012///
SN  - 1535-4970
SP  - 653
TI  - A comparison between two strategies for monitoring hepatic function during antituberculous therapy
T2  - Am J Respir Crit Care Med
UR  - http://dx.doi.org/10.1164/rccm.201105-0850OC
UR  - http://www.ncbi.nlm.nih.gov/pubmed/22198973
VL  - 185
ER  -
Download