Risk factors for drug-induced liver injury in tuberculosis patients: a meta-analysis and systematic review

Objective: A meta-analysis and systematic review of risk factors for drug-induced liver injury in tuberculosis patients. Methods: Computerized searches were conducted in PubMed, Embase, Web of Science, and the Cochrane Library databases to identify studies investigating risk factors for drug-induced liver injury in tuberculosis patients. The search period spanned from the inception of each database to January 2026. Two researchers independently screened studies, extracted data, and assessed risk of bias in included studies. Meta-analysis was performed using Stata 15.0 software. Results: A total of 41 studies involving 34,251 subjects were included. Meta-analysis revealed that female gender [OR = 1.35, 95% CI (1.05, 1.73)], alcohol consumption [OR = 2.07, 95% CI (1.57, 2.72)], extrapulmonary tuberculosis [OR = 2.01, 95% CI (1.66, 2.44)], disseminated TB [OR = 1.74, 95% CI (1.18, 2.59)], albumin <35 g/L [OR = 2.16, 95% CI (1.52, 3.06)], Malnutrition [OR = 3.32, 95% CI (1.52, 7.24)], HIV [OR = 1.80, 95% CI (1.09, 2.99)], HCV [OR = 2.17, 95% CI (1.10, 4.29)], hepatotoxic drugs [OR = 2.65, 95% CI (1.58, 4.43)] may constitute risk factors for drug-induced liver injury in tuberculosis patients. Conclusion: Female gender, alcohol consumption, extrapulmonary tuberculosis, disseminated tuberculosis, serum albumin levels below 35 g/L, malnutrition, HIV infection, HBsAg positivity, HCV infection, and hepatotoxic drugs may constitute risk factors for drug-induced liver injury in tuberculosis patients. Given limitations in the number and quality of included studies, these findings require validation through further high-quality research. Systematic review registration: This study has been registered on the PROSPERO platform, registration number: CRD420261302758.