Clinical characteristics and host factors associated with drug-induced liver injury in 264 pulmonary tuberculosis patients from Hainan province, China

Tuberculosis (TB) remains a major global public-health threat. Yet clinical portraits of patients in China's tropical south—especially Hainan—are still thinly documented. We set out to characterize the presentation of pulmonary TB on the island, quantify the impact of molecular diagnostics, and ask how sex, age, and diabetes shape both disease expression and treatment safety. We retrospectively reviewed the charts of 264 culture- or GeneXpert-confirmed pulmonary-TB cases admitted to the Hainan branch of the PLA General Hospital between June 2013 and August 2025. Patients were stratified by sex, age (cut-off 60 years), diabetes status, and date of admission (before vs. after June 2019, when GeneXpert was introduced). Continuous and categorical variables were analyzed in GraphPad Prism 10; p < 0.05 defined significance. Of 264 patients (175 men, 89 women; median age 58 years), key findings were: (1) Diagnostic speed: median time to initial diagnosis fell from 5 days (IQR 1–7) pre-2019 to 1 day (IQR 1–7) after molecular testing was adopted ( p = 0.0018). (2) Sex: men had more pleural effusion ( p = 0.0067) and a higher incidence of drug-induced liver injury after treatment (35/115 vs 9/65; p = 0.0182). They also exhibited higher leukocyte, neutrophil, haemoglobin, CRP, procalcitonin, and IL-6 levels (all p < 0.05). (3) Age: patients ≥60 years showed more multi-lobar involvement, more dyspnoea, higher neutrophil counts, CRP, procalcitonin, and IL-6, but lower haemoglobin than younger adults (all p < 0.05). (4) Diabetes: the 60 diabetic patients had a higher body mass index (BMI) (22.60 ± 3.38 vs 20.79 ± 3.35 kg m −2 ; p = 0.0004), yet no significant divergence in symptoms or inflammatory markers. (5) Imaging: patchy infiltrates predominated (49.62 %), followed by nodules (26.37 %) and cavitation (18.94 %). Rolling out molecular diagnostics in Hainan compressed the diagnostic window dramatically. Host factors—male sex and older age—were linked to heavier inflammation and a greater risk of hepatotoxicity. These data argue for universal rapid molecular testing and sex-/age-tailored monitoring of adverse drug reactions in routine TB care. • GeneXpert MTB/RIF shortened the median time to pulmonary TB diagnosis in Hainan from 5 days to 1 day ( P = 0.0018). • Male patients showed a 2.5-fold higher incidence of anti-TB drug-induced liver injury than females. • Adults ≥60 years presented with more multi-lobar disease, dyspnoea, and elevated inflammatory markers. • Diabetic TB patients had higher BMI yet no significant differences in symptoms or systemic inflammation. • Rapid molecular testing and tailored hepatotoxicity monitoring are advocated for routine TB care in tropical China.