ArticleBMC infectious diseases2026
Risk factors for tigecycline-associated drug-induced liver injury in critically Ill patients: a 2020-2023 retrospective study from a Chinese hospital.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTigecycline is extensively used in Chinese intensive care unit (ICU) for multidrug-resistant infections, yet the profile of its associated drug-induced liver injury (DILI) requires further investigation. Therefore, this study was designed to explore the incidence, identify independent predictors, and characterize the dose-response relationship and timing of tigecycline-associated DILI in critically ill patients.
methodsThis single-center, retrospective cohort study enrolled all critically ill patients (n = 309) who received intravenous tigecycline between 2020 and 2023. DILI was diagnosed according to established international biochemical criteria (n = 71). We employed Pearson correlation analysis and multivariable logistic regression to assess relationships between clinical factors and DILI development. The dose-response relationship between tigecycline exposure and DILI risk was characterized using ROC analysis and generalized additive models (GAM). Time-to-onset of DILI was evaluated using Kaplan-Meier analysis to estimate cumulative incidence and median event time.
resultsThe incidence of tigecycline-associated DILI was 23.0%. Multivariable analysis identified total duration of tigecycline therapy (OR = 2.01 per week, 95% CI: 1.42-2.92) and cumulative tigecycline dose (OR = 1.51 per gram, 95% CI: 1.19-1.94) as significant independent risk factors. The dose-response relationship was found to be non-linear, with a GAM revealing an initial increase in risk that attenuated at higher cumulative doses (P < 0.05). The cumulative dose of tigecycline was associated with DILI (AUC = 0.647). The median time to DILI onset among affected patients was 4 days; the Kaplan‑Meier estimate of median DILI‑free survival in the full cohort was 18 days.
conclusionsIn patients who develop DILI, the median onset time of 4 days underscores the importance of early hepatic monitoring; the 18‑day Kaplan‑Meier estimate further supports extended vigilance throughout prolonged therapy. Cumulative dose and treatment duration should be managed to mitigate the risk of hepatotoxicity. CLINICAL TRIAL NUMBER: Not applicable.
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