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Background <p>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.</p> Methods <p>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&#xa0;months.</p> Results <p>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&#xa0;(78.9%) had a resolution of tuberculosis and four (21.1%) died. The cause for death in all four patients was related to cirrhosis.</p> Conclusion <p>As per our study, patients with decompensated cirrhosis tolerated the CTP-score-based modified ATT and almost 80% had a resolution of tuberculosis. </p> Graphical Abstract <p></p>

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Child-Turcotte-Pugh score-based modified anti-tubercular treatment in patients with decompensated cirrhosis with tuberculosis: A two-year retrospective observational study from North India

  • 期刊论文

  • 发表日期：

    2025年8月29日

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  • Juned Ahmad

摘要

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.

Graphical Abstract