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Patients were stratified into three groups based on ICG retention rate at 15\u00a0min (ICG-R15): augmented (AHC, ICG-R15\u2009&lt;\u20096%), normal (NHC, 6% \u2264 ICG-R15\u2009\u2264\u200912%), and impaired hepatic clearance (IHC, ICG-R15\u2009&gt;\u200912%). Trough concentrations were measured for the following antibiotics: imipenem\/cilastatin, piperacillin\/tazobactam, voriconazole, linezolid, vancomycin, cefoperazone\/sulbactam, and teicoplanin. Correlations between ICG clearance parameters (ICG-R15 and ICG plasma disappearance rate [PDR] ) and antibiotic concentrations were analyzed. Multivariate logistic regression and ROC analysis were performed to identify independent predictors of subtherapeutic concentrations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nearly half of the cohort (49.5%, 46\/93) presented with AHC. The 28-day mortality rate was highest in the IHC group (48.4%), with no significant difference between the AHC (10.9%) and NHC (12.5%) groups. Trough concentrations of hepatically or partially cleared antibiotics (voriconazole and linezolid) showed strong correlations with ICG-R15 (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.679 and\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.626, respectively) and ICG-PDR (\n                      <jats:italic>r<\/jats:italic>\n                      = -0.673 and\n                      <jats:italic>r<\/jats:italic>\n                      = -0.629, respectively; all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). No significant correlations were found for renally cleared antibiotics (imipenem, piperacillin). Multivariate analysis identified ICG-PDR as the only independent predictor of subtherapeutic concentrations for hepatically or partially eliminated antibiotics (OR\u2009=\u20090.885, 95% CI: 0.807\u20130.970,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009). In ROC analysis, ICG-PDR demonstrated excellent predictive performance for the entire antibiotic cohort (AUC\u2009=\u20090.853,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with a sensitivity of 89.5% and specificity of 72.6% at the optimal cut-off of 20.65%\/min. When specifically applied to hepatically cleared antibiotics, it remained a strong predictor (AUC\u2009=\u20090.791,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), with a cut-off of 21.55%\/min yielding a sensitivity of 81.8% and specificity of 71.1%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AHC is a prevalent phenotype in sepsis and identifies a patient subgroup at high risk for subtherapeutic concentrations of hepatically or partially cleared antibiotics. ICG-derived parameters, particularly ICG-PDR, are robust predictors of inadequate drug exposure, supporting the use of dynamic liver function monitoring to optimize antibiotic dosing in septic patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12871-025-03534-9","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T02:56:11Z","timestamp":1765335371000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["ICG clearance as an indicator of augmented hepatic clearance and subtherapeutic drug concentrations in septic patients"],"prefix":"10.1186","volume":"26","author":[{"given":"Ying","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoting","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenkui","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danjiang","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Qu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"issue":"1","key":"3534_CR1","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1186\/s13054-022-04163-1","volume":"26","author":"R Perez","year":"2022","unstructured":"Perez R, de Garibay A, Kortgen A, Leonhardt J, Zipprich A, Bauer M. 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