Objective  To explore the characteristics and influencing factors of drug-induced liver injury (DILI) associated with the postoperative use of propacetamol, and to provide guidance for rational clinical medication.

Methods  A retrospective analysis was conducted on hospitalized patients who underwent surgical treatment and were administered propacetamol from January 2022 to June 2024. Cases were screened based on established inclusion and exclusion criteria. Statistical analyses were performed on patients’ demographic data, medication information, liver function indicators before and after medication, comorbid conditions, and concomitant medications to assess the incidence and influencing factors of propacetamol-related DILI. A multivariate Logistic regression analysis was conducted to identify related risk factors.

Results  A total of 7,579 patients were sampled, of which 2,114 met the inclusion criteria. Among them, 531 patients (25.1%) experienced DILI, primarily presenting with abnormal liver function indicators. This included elevated alanine aminotransferase in 379 cases (71.4%), elevated aspartate aminotransferase in 197 cases (37.1%), elevated alkaline phosphatase in 209 cases (39.4%), and elevated total bilirubin in 92 cases (17.3%). Univariate analysis revealed that there were significant differences in gender, height, age, weight, body mass index (BMI), duration of propacetamol use, total medication dosage, concomitant use of hepatic-metabolized antibiotics, and history of liver disease between the DILI group and non-DILI group (P<0.05). Multivariate Logistic regression analysis showed that patient gender, BMI, total propacetamol dosage, liver-related diseases, and concomitant use of hepatic-metabolized antibiotics as independent risk factors for DILI (P<0.05).

Conclusion  The use of propacetamol for postoperative analgesia presents a risk for liver injury, and the risk is particularly pronounced in males, obesity, high-dose dosing, patients with underlying hepatic disease, and comorbid hepatic metabolism of antimicrobial drug use. It is recommended to strengthen the monitoring of liver function in clinical application, strictly control the dosage and duration of treatment, and avoid co-administration with hepatotoxic drugs to ensure the safety of drug use.

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