The Albumin-to-Alkaline Phosphatase Ratio and Drug-Induced Liver Injury Induced by Initial Anti-Tuberculosis Treatment

ZOU Yanmei; CHEN Hongxia; WANG Jian; MA Lingfang; MA Shoumei

doi:10.3639/j.issn.2095-3097.2025.11.022

Abstract：Objective To explore the relationship between the albumin-to-alkaline phosphatase ratio(AAPR)and drug-induced liver injury(DILI)induced by initial anti-tuberculosis therapy.Methods Fifty-seven pulmonary tuberculosis patients who developed DILI during initial anti-tuberculosis therapy from June 2024 to January 2025 in our hospital were selected as the DILI group,and another 360 pulmonary tuberculosis patients who did not develop DILI during initial anti-tuberculosis therapy in the same period were selected as the non-DILI group.The levels of albumin(ALB),alkaline phosphatase(ALP),and AAPR were compared between the two groups.The predictive value of ALB,ALP,and AAPR for DILI in patients receiving initial anti-tuberculosis therapy was evaluated using the receiver operating characteristic curve.Multivariate logistic stepwise regression was used to analyze the influencing factors for DILI in patients undergoing initial anti-tuberculosis therapy.Results The levels of ALB and AAPR in the DILI group were lower than those in the non-DILI group,while the ALP level was higher(P<0.05).The areas under the curve of ALB,ALP,and AAPR for predicting DILI in patients receiving initial anti-tuberculosis therapy were 0.853(0.800-0.906),0.774(0.721-0.827),and 0.909(0.856-0.962),respectively.The cut-off values were 39.04 g/L,111.08 U/L,and 0.35,respectively.The specificities were 67.96%,58.34%,and 89.05%,respectively,and the sensitivities were 92.56%,92.56%,and 86.11%,respectively.The proportion of patients aged≥60 years and those with a history of diabetes in the DILI group was higher than that in the non-DILI group,the hemoglobin level was lower,and the levels of aspartate aminotransferase,alanine aminotransferase,and total bilirubin were higher(P<0.05).Multivariate analysis showed that age≥60 years(OR=1.962,95%CI:1.401-2.749)and a history of diabetes(OR=2.073,95%CI:1.480-2.904)were risk factors for DILI in patients undergoing initial anti-tuberculosis therapy,while ALB≥39.04 g/L(OR=0.410,95%CI:0.273-0.616)and AAPR≥0.35(OR=0.381,95%CI:0.250-0.581)were protective factors(P<0.05).Conclusions A low AAPR is associated with DILI in patients undergoing initial anti-tuberculosis therapy and can serve as an important marker for predicting DILI.