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Teicoplanin total trough concentration and adverse effects in patients with hypoalbuminemia
Hirofumi Oishi1, Yoshimichi Koutake2, Narumi Ebata1
1Department of Pharmacy, NHO Kyushu Medical Center, 1-8-1 Jigyouhama, Chuo-ku, Fukuoka, 810-8563, Japan.
Background:
The association between Teicoplanin (TEIC) total trough concentration (Cmin) and adverse effects (hepatotoxicity, nephrotoxicity, and thrombocytopenia) in patients with hypoalbuminemia remains poorly understood. We examined this association for patients with hypoalbuminemia from a safety perspective.
Methods:
This retrospective study included adult patients (≥18 years) who received TEIC at Kyushu Medical Center between April 2013 and March 2024, underwent therapeutic drug monitoring, and had persistent serum albumin <2.5 g/dL. The primary outcome was the occurrence of hepatotoxicity, nephrotoxicity, and thrombocytopenia. Multivariate logistic regression analysis evaluated the association between TEIC Cmin and each adverse event.
Results:
Hepatotoxicity, nephrotoxicity, and thrombocytopenia were reported in 13.5 % (33/245), 19.0 % (42/221), and 14.4 % (22/153) of patients, respectively. TEIC Cmin ≥ 21.1 μg/mL, serum albumin <2.0 g/dL, and total parenteral nutrition were associated with hepatotoxicity. Hepatitis/liver cirrhosis and vasopressor use were associated with nephrotoxicity. The factors associated with thrombocytopenia included estimated glomerular filtration rate <30 mL/min/1.73 m2, platelet counts ≤150 × 103/μL, hyperuricemia, and hematologic disorders.
Conclusions:
Our findings suggest that a TEIC Cmin ≥ 21.1 μg/mL may increase the risk of TEIC-induced hepatotoxicity in patients with hypoalbuminemia. These findings may need to be validated in further studies.
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