Analysis of drug-induced liver injury in adult patients caused by ceftriaxone

Objective：To identify clinical risk factors for drug-induced liver injury in adult patients when using ceftriaxone. Methods：A total of 384 hospitalized adult patients receiving ceftriaxone treatment were selected in the Zhongshan Hospital, Fudan University from January 2015 to December 2016. The baseline characteristics, diagnoses and sites of infection, comorbidities, concomitant medications, and laboratory data indicating liver function before and after treatment, were recorded. The patients were divided into the high-dose (＞2 g/d) ceftriaxone group and the low-dose (≤2 g/d) ceftriaxone group, and the incidence of drug-induced liver injury between the two groups was compared. Furthermore, patients were divided into liver-injury group and non-liver-injury group, and the applications of ceftriaxone were analyzed. Results：Sixty-six (17.2%) cases received high-dose ceftriaxone, and 318 (82.8%) cases received low-dose ceftriaxone. Among the 384 cases, 12 (3.1%) cases experienced liver injury during the ceftriaxone treatment, the incidence of liver injury in the high-dose ceftriaxone group was higher than that in the low-dose group (13.6% vs 0.9%; OR=16.58, 95%CI 4.35-63.11, P<0.001); 44 (11.4%) cases experienced mild liver injury, and the incidence of mild liver injury in the high-dose group was also higher than that in the low-dose group (25.8% vs 8.5%; OR=3.74, 95% CI 1.90-7.37, P<0.001). Univariate analysis revealed that high-dose ceftriaxone (＞2 g/d) was an risk factor for drug-induced liver injury (OR=16.58, 95% CI 4.35-63.11, P<0.001). Conclusions：High-dose (＞2 g/d) ceftriaxone was associated with a significantly higher incidence of drug-induced liver injury, and might be a risk factor for drug-induced liver injury in adult patients.