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Deleterious influence of pyrazinamide on the outcome of patients with fulminant or subfulminant liver failure during antituberculous treatment including isoniazid
Author(s) -
Durand François,
Bernuau Jacques,
Pessayre Dominique,
Samuel Didier,
Belaiche Jacques,
Degott Claude,
Bismuth Henri,
Belghiti Jacques,
Erlinger Serge,
Rueff Bernard,
Benhamou Jean Pierre
Publication year - 1995
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840210407
Subject(s) - pyrazinamide , medicine , isoniazid , rifampicin , gastroenterology , liver transplantation , fulminant hepatitis , fulminant , fulminant hepatic failure , hepatology , transplantation , hepatitis , tuberculosis , pathology
Isoniazid and pyrazinamide are well‐known hepatotoxic drugs, often used in combination. The aim of this study was to assess the prognostic influence of pyrazinamide on the outcome of fulminant or subfulminant liver failure caused by antituberculous therapy. Eighteen patients with fulminant or subfulminant liver failure due to antituberculous therapy were studied. Nine patients received isoniazid and rifampicin without pyrazinamide (group 1), and nine patients received isoniazid and rifampicin together with pyrazinamide (group 2). The severity of fulminant and subfulminant liver failure, as judged by the prevalence of coma and the lowest level of factor V, was similar in the two groups. Spontaneous survival was greater in group 1 (eight of nine) than in group 2 (two of nine) ( P < .02). The authors conclude that pyrazinamide co‐administration was associated with an increased mortality in patients with fulminant or subfulminant hepatitis occurring during antituberculous therapy. In these patients, pyrazinamide administration and an interval of more than 15 days between the onset of antituberculous treatment and jaundice, combined with grade III encephalopathy and factor V below 20%, predicted death without liver transplantation. (H EPATOLOGY 1995; 21:929–932.)