Risk evaluation of ampicillin/sulbactam-induced liver injury based on albumin-bilirubin score

Abstract

BackgroundDrug-induced liver injury (DILI) is an adverse reaction caused by ampicillin/sulbactam (ABPC/SBT). The albumin-bilirubin (ALBI) score is an index of hepatic functional reserve. However, the relationship between ABPC/SBT-induced DILI and ALBI score remains unknown; therefore, we aimed to elucidate the risk of ABPC/SBT-induced DILI based on the ALBI score. MethodsThis was a single-center, retrospective, case-control study using electronic medical records. A total of 380 patients were enrolled in the present study, and the primary outcome was ABPC/SBT-induced DILI. The ALBI score was calculated using serum albumin and total bilirubin levels. In addition, we performed COX regression analysis using age ≥75 years, dose ≥9 g/day, alanine aminotransferase (ALT) ≥21 IU/L, and ALBI score ≥–2.00 as covariates. We also performed 1:1 propensity score matching between non-DILI and DILI groups. ResultsThe incidence of DILI was 9.5% (36/380). According to COX regression analysis, the adjusted hazard ratio for ABPC/SBT-induced DILI with an ALBI score ≥–2.00 was 2.55 (95% confidence interval: 1.256–5.191, P = 0.010), suggesting that patients with baseline ALBI score ≥–2.00 may be at high risk for ABPC/SBT-induced DILI. However, significant differences were not observed in cumulative risk for DILI between non-DILI and DILI patients regarding an ALBI score ≥–2.00 after propensity score matching (P = 0.146). ConclusionThese findings suggest that ALBI score may be a simple and potentially useful index for predicting ABPC/SBT-induced DILI. In patients with an ALBI score ≥–2.00, frequent liver function monitoring should be considered to prevent ABPC/SBT-induced DILI.