Assessment of the risk of developing cefepime-induced abnormal liver enzyme levels using the albumin-bilirubin score and fibrosis-4 index: a single-centre retrospective case-control study.

Background: Although the albumin-bilirubin (ALBI) score and fibrosis-4 (FIB-4) index may help predict cefepime-induced liver enzyme abnormalities, the relationship between these measures and liver enzyme abnormalities has not been elucidated.

Objectives: This study investigated the relevance and predictive accuracy of the ALBI score and FIB-4 index for cefepime-induced liver enzyme abnormalities.

Patients and methods: This single-centre retrospective case-control study included 473 patients. The primary outcomes were cefepime-induced abnormal liver enzyme levels. Cox regression analysis was performed with male sex, cumulative dose (≥36 g), concomitant use of acetaminophen or voriconazole, alkaline phosphatase (≥238 IU/L), ALBI score (≥-1.45) and FIB-4 index (≥4.69) as explanatory variables. The predictive accuracies of the ALBI score and FIB-4 index were evaluated based on the AUC using the receiver operating characteristic curve. We performed 1:1 propensity score matching between FIB-4 index ≥4.69 and FIB-4 index < 4.69 groups.

Results: The incidence of abnormal liver enzyme levels was 15.6% (74/473). Cox regression analysis revealed that the ALBI score (adjusted hazard ratio, 2.10; 95% CI, 1.268-3.491; P = 0.004) and FIB-4 index (adjusted hazard ratio, 2.33; 95% CI, 1.425-3.796; P = 0.001) were independent risk factors for liver enzyme abnormalities. For all patients, the FIB-4 index (AUC: 0.629) exceeded the ALBI score (AUC: 0.530). Similar results were observed even after propensity score matching.

Conclusions: The progression of liver fibrosis before cefepime administration, as assessed using the FIB-4 index, could be more useful than the ALBI score in predicting the risk of developing abnormal liver enzyme levels.