Voriconazole-associated liver injury: clinical risk factor identification and predictive nomogram construction.

Objective: Investigate the high risk factors contributed to voriconazole-induced liver injury and develop a predictive nomogram for voriconazole-induced liver injury risk, thereby optimizing the clinical medication safety. Methods: This observational study retrospectively analyzed the electronic health records of hospitalized patients who received voriconazole treatment or prophylaxis at a tertiary hospital. Patients who met the inclusion and exclusion criteria were enrolled between June 2020 and June 2024, and their general biological data were collected. The diagnosis and severity grading of voriconazole-associated liver injury were determined according to the diagnostic and treatment guidelines for drug-induced liver injury. Patients were categorized into liver injury and non-injury groups based on the results of post-treatment liver function tests. Associations between baseline characteristics and liver injury were analyzed using non-parametric and chi-squared tests. To avoid omitting potentially significant factors, variables demonstrating Results: Among the 1,964 patients screened, 1,196 were excluded, leaving 768 patients included in the statistical analysis. Liver injury occurred in 95 patients, resulting in an incidence rate of 12.4%. Multivariable logistic regression analysis demonstrated that total cholesterol (TC) (OR = 1.893, Conclusion: Concomitant use of ezetimibe, caspofungin, glucocorticoids, and TC levels exceeding 4.485 mmol/L are independent risk factors for voriconazole-induced liver injury. The developed nomogram model offers clinically meaningful predictions for drug-induced liver injury risk, facilitating the optimization of voriconazole therapy safety.