Voriconazole-induced liver injury: incidence patterns and risk factors in a retrospective cohort

作者：Yan Lou, Yu Wang, Jing Liu, Yujing Wang, Jiaqi Wang, Shuang Ma, Zongming Yang, Jingsong Li, Yunqing Qiu · 发表于：Antimicrobial Agents and Chemotherapy · 年份：2025 · DOI：10.1128/aac.00487-25 · 被引用次数：8 · 研究领域：Drug-Induced Hepatotoxicity and Protection、Antibiotic Resistance in Bacteria、Amoebic Infections and Treatments

ABSTRACT Voriconazole, a first-line therapy for invasive aspergillosis, carries hepatotoxicity risks lacking comprehensive epidemiological characterization. Current evidence is limited by heterogeneity in diagnostic criteria (e.g., varying thresholds for liver function abnormalities across studies), insufficient sample sizes, and inadequate adjustment for comorbidities, which compromises risk assessment accuracy. This study aims to systematically characterize the epidemiological profile of voriconazole-induced liver injury and identify modifiable independent risk factors. We analyzed 7,659 voriconazole-treated adults (2007–2020) from the First Affiliated Hospital of Zhejiang University to determine incidence and injury subtypes. Univariable and multivariable logistic regression identified risk factors, with model performance evaluated by ROC (receiver-operating characteristic) analysis; sensitivity analyses addressed potential confounders. In our results, voriconazole-induced liver injury occurred in 11.32% of patients, predominantly manifesting as hepatocellular (5.01%, 279/630), cholestatic (5.19%, 289/630), and mixed-pattern injuries (1.11%, 62/630). Key modifiable risk factors included intravenous administration (odds ratio [OR] = 1.88, 95% confidence interval [CI]: 1.43–2.46). Non-modifiable predictors comprised baseline elevated urea (OR = 1.47, 95% CI: 1.08–2.02), elevated triglycerides (TG) (cholestatic injury: OR = 1.47, 95% CI: 1.08–2.02), elevated C-reactive protei...