{"title":"白蛋白-胆红素-纤维化-4评分预测接受治疗药物监测的患者teicoplanin诱导的异常肝酶水平：一项多中心回顾性队列研究。","authors":"Hayahide Ooi, Yuki Asai, Yoshihiro Kondo, Takumi Tashiro, Nobuyuki Zakoji, Maria Aoki, Yoshiki Koriyama, Takuya Iwamoto, Masaaki Takahashi","doi":"10.1177/10600280251319519","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Although therapeutic drug monitoring (TDM) maintains serum teicoplanin (TEIC) concentration between 15 and 30 μg/mL, TEIC-induced liver injury may still occur. The albumin-bilirubin (ALBI)-fibrosis-4 (FIB-4) score may be useful for predicting TEIC-induced liver injury in patients undergoing TDM.</p><p><strong>Objective: </strong>This pilot study aimed to investigate whether the ALBI-FIB4 score can predict TEIC-induced abnormal liver enzyme levels in patients undergoing TDM.</p><p><strong>Methods: </strong>The multicenter retrospective cohort study included 140 patients undergoing TDM of TEIC at steady state. The primary outcome was TEIC-induced abnormal liver enzyme levels. Cut-off values for the alanine aminotransferase (ALT), ALBI score, FIB-4 index, and ALBI-FIB4 score were detected using receiver-operating characteristic curves. The cumulative risk of TEIC-induced abnormal liver enzyme levels was evaluated using Kaplan-Meier curves analyzed log-rank test. Subgroup analysis was performed to examine cumulative risk in patients with serum TEIC concentration of <30 μg/mL.</p><p><strong>Results: </strong>The incidence of TEIC-induced abnormal liver enzyme levels was 14.3% (20/140). Cut-off values were 24 IU/L for ALT (sensitivity: 0.800; specificity: 0.692; area under the curve [AUC]: 0.753), -1.33 for the ALBI score (sensitivity: 0.550; specificity: 0.617; AUC: 0.539), 2.73 for the FIB-4 index (sensitivity: 0.700; specificity: 0.475; AUC: 0.550), and -0.85 for the ALBI-FIB4 score (sensitivity: 0.800; specificity: 0.467; AUC: 0.572). The cumulative risk of TEIC-induced abnormal liver enzyme levels was significantly higher for patients with ALT ≥24 IU/L (<i>P</i> < 0.01) and ALBI-FIB4 score ≥-0.85 (<i>P</i> = 0.042). Patients with a serum TEIC concentration of <30 µg/mL exhibited a similar trend, with a higher cumulative risk for patients with ALBI-FIB4 score ≥-0.85 (<i>P</i> = 0.058).</p><p><strong>Conclusion and relevance: </strong>An ALBI-FIB4 score ≥-0.85 may serve as a potential predictor for TEIC-induced abnormal liver enzyme levels in patients undergoing TDM. However, evidence supporting this threshold requires further statistical validation using a larger dataset.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251319519"},"PeriodicalIF":2.3000,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Albumin-Bilirubin-Fibrosis-4 Score for Predicting Teicoplanin-Induced Abnormal Liver Enzyme Levels in Patients Undergoing Therapeutic Drug Monitoring: A Multicentral Retrospective Cohort Study.\",\"authors\":\"Hayahide Ooi, Yuki Asai, Yoshihiro Kondo, Takumi Tashiro, Nobuyuki Zakoji, Maria Aoki, Yoshiki Koriyama, Takuya Iwamoto, Masaaki Takahashi\",\"doi\":\"10.1177/10600280251319519\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Although therapeutic drug monitoring (TDM) maintains serum teicoplanin (TEIC) concentration between 15 and 30 μg/mL, TEIC-induced liver injury may still occur. The albumin-bilirubin (ALBI)-fibrosis-4 (FIB-4) score may be useful for predicting TEIC-induced liver injury in patients undergoing TDM.</p><p><strong>Objective: </strong>This pilot study aimed to investigate whether the ALBI-FIB4 score can predict TEIC-induced abnormal liver enzyme levels in patients undergoing TDM.</p><p><strong>Methods: </strong>The multicenter retrospective cohort study included 140 patients undergoing TDM of TEIC at steady state. The primary outcome was TEIC-induced abnormal liver enzyme levels. Cut-off values for the alanine aminotransferase (ALT), ALBI score, FIB-4 index, and ALBI-FIB4 score were detected using receiver-operating characteristic curves. The cumulative risk of TEIC-induced abnormal liver enzyme levels was evaluated using Kaplan-Meier curves analyzed log-rank test. Subgroup analysis was performed to examine cumulative risk in patients with serum TEIC concentration of <30 μg/mL.</p><p><strong>Results: </strong>The incidence of TEIC-induced abnormal liver enzyme levels was 14.3% (20/140). Cut-off values were 24 IU/L for ALT (sensitivity: 0.800; specificity: 0.692; area under the curve [AUC]: 0.753), -1.33 for the ALBI score (sensitivity: 0.550; specificity: 0.617; AUC: 0.539), 2.73 for the FIB-4 index (sensitivity: 0.700; specificity: 0.475; AUC: 0.550), and -0.85 for the ALBI-FIB4 score (sensitivity: 0.800; specificity: 0.467; AUC: 0.572). The cumulative risk of TEIC-induced abnormal liver enzyme levels was significantly higher for patients with ALT ≥24 IU/L (<i>P</i> < 0.01) and ALBI-FIB4 score ≥-0.85 (<i>P</i> = 0.042). Patients with a serum TEIC concentration of <30 µg/mL exhibited a similar trend, with a higher cumulative risk for patients with ALBI-FIB4 score ≥-0.85 (<i>P</i> = 0.058).</p><p><strong>Conclusion and relevance: </strong>An ALBI-FIB4 score ≥-0.85 may serve as a potential predictor for TEIC-induced abnormal liver enzyme levels in patients undergoing TDM. However, evidence supporting this threshold requires further statistical validation using a larger dataset.</p>\",\"PeriodicalId\":7933,\"journal\":{\"name\":\"Annals of Pharmacotherapy\",\"volume\":\" \",\"pages\":\"10600280251319519\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-03-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Pharmacotherapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/10600280251319519\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Pharmacotherapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10600280251319519","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
The Albumin-Bilirubin-Fibrosis-4 Score for Predicting Teicoplanin-Induced Abnormal Liver Enzyme Levels in Patients Undergoing Therapeutic Drug Monitoring: A Multicentral Retrospective Cohort Study.
Background: Although therapeutic drug monitoring (TDM) maintains serum teicoplanin (TEIC) concentration between 15 and 30 μg/mL, TEIC-induced liver injury may still occur. The albumin-bilirubin (ALBI)-fibrosis-4 (FIB-4) score may be useful for predicting TEIC-induced liver injury in patients undergoing TDM.
Objective: This pilot study aimed to investigate whether the ALBI-FIB4 score can predict TEIC-induced abnormal liver enzyme levels in patients undergoing TDM.
Methods: The multicenter retrospective cohort study included 140 patients undergoing TDM of TEIC at steady state. The primary outcome was TEIC-induced abnormal liver enzyme levels. Cut-off values for the alanine aminotransferase (ALT), ALBI score, FIB-4 index, and ALBI-FIB4 score were detected using receiver-operating characteristic curves. The cumulative risk of TEIC-induced abnormal liver enzyme levels was evaluated using Kaplan-Meier curves analyzed log-rank test. Subgroup analysis was performed to examine cumulative risk in patients with serum TEIC concentration of <30 μg/mL.
Results: The incidence of TEIC-induced abnormal liver enzyme levels was 14.3% (20/140). Cut-off values were 24 IU/L for ALT (sensitivity: 0.800; specificity: 0.692; area under the curve [AUC]: 0.753), -1.33 for the ALBI score (sensitivity: 0.550; specificity: 0.617; AUC: 0.539), 2.73 for the FIB-4 index (sensitivity: 0.700; specificity: 0.475; AUC: 0.550), and -0.85 for the ALBI-FIB4 score (sensitivity: 0.800; specificity: 0.467; AUC: 0.572). The cumulative risk of TEIC-induced abnormal liver enzyme levels was significantly higher for patients with ALT ≥24 IU/L (P < 0.01) and ALBI-FIB4 score ≥-0.85 (P = 0.042). Patients with a serum TEIC concentration of <30 µg/mL exhibited a similar trend, with a higher cumulative risk for patients with ALBI-FIB4 score ≥-0.85 (P = 0.058).
Conclusion and relevance: An ALBI-FIB4 score ≥-0.85 may serve as a potential predictor for TEIC-induced abnormal liver enzyme levels in patients undergoing TDM. However, evidence supporting this threshold requires further statistical validation using a larger dataset.
期刊介绍：
Annals of Pharmacotherapy (AOP) is a peer-reviewed journal that advances pharmacotherapy throughout the world by publishing high-quality research and review articles to achieve the most desired health outcomes.The articles provide cutting-edge information about the most efficient, safe and cost-effective pharmacotherapy for the treatment and prevention of various illnesses. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 14 days
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