Purpose: To investigate the risk factors of linezolid-induced haematological toxicity in hospitalized patients.
Methods: In this retrospective, single-center, observational cohort study, patients underwent linezolid TDM trough concentration (Cmin) during treatment between January 2020 and December 2021 were analysed.Univariate and multivariate logistic regression analysis were used to investigate the relevant risk variables, and a relative operating characteristic (ROC) curve was generated to predict clinical characteristics.
Results: A total of 111 valid individuals were studied, among which 47 were diagnosed with linezolidine-related thrombocytopenia and 18 were diagnosed with linezolidine-related hemoglobin decrease, respectively. Binary logistic regression analysis showed that creatinine clearance level (Ccr) <50 ml/min/1.73 m2 [OR, 5.463; 95% Cl, 1.249-23.888, P=0.024] and the plasma trough concentration >7mg/L [OR, 62.660; 95% Cl, 14.293-274.708, P=0.001] were risk factors associated with thrombocytopenia induced by linezolid. The area under the ROC curve of linezolid plasma trough concentration was 0.955, the Youden index was 0.837 at the maximum, and the corresponding critical value was 6.94 mg/L, with a sensitivity of 91.5% and a specificity of 92.2%. Moreover, Ccr <50 ml/min/1.73 m2 [OR, 7.282; 95% Cl, 1.765-30.048, P=0.006] and the plasma trough concentration >7mg/L[OR, 6.364; 95% Cl, 1.937-20.910, P=0.020] were closely related to linezolid related hemoglobin reduction. The area under the ROC curve of linezolid plasma trough concentration was 0.755, the Youden index was 0.477 at the maximum, and the corresponding critical value was 7.53 mg/L, with a sensitivity of 77.8% and a specificity of 69.9%.
Conclusion: Renal insufficiency is a related risk factor for linezolid-induced haematological toxicity. It is recommended that patients treated with linezolid should monitor blood routine and plasma concentration, especially in patients with moderate or severe renal insufficiency. Plasma trough concentration of linezolid could be a suitable predictor for linezolid-related thrombocytopenia and anemia.