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.

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.