Baseline keratin-18 level and risk of anti-tuberculosis drug-induced liver injury: An individual matched case-control study

Anti-tuberculosis drug-induced liver injury (ATLI) presents a grand challenge to the global control of tuberculosis. Serum keratin-18 may have a certain predictive value for the occurrence of liver injury. The purpose of this study is to examine the correlation between baseline serum keratin-18 levels and ATLI risk among the eastern Chinese Han population. Employing a 1:2 individual matched case-control approach, the study encompassed 88 ATLI cases and 176 controls. Univariate and multivariate conditional logistic regression analyses were performed to evaluate the association between baseline keratin-18 levels and ATLI risk. Furthermore, area under the curve (AUC) was used to assess keratin-18’s efficacy in distinguishing ATLI cases from controls. In ATLI cases, baseline keratin-18 levels were significantly lower than controls (188.8 vs. 234.9 ng/L, P = 0.044), with higher levels associated with reduced ATLI risk (OR = 0.995, 95% CI: 0.992-0.999, P = 0.005). Under the optimal keratin-18 cut-off value of 191.6 ng/L, the AUCs were equal to 0.577 (95% CI: 0.513-0.640, P = 0.018) in univariate analysis and 0.597 (95% CI: 0.524-0.670, P = 0.010) in multivariate analysis. The present study indicated that the higher the baseline keratin-18 concentration in tuberculosis patients of eastern Chinese Han population, the lower the risk of ATLI.