{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:04:39Z","timestamp":1790661879706,"version":"4.1.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tigecycline is widely used for severe infections and infections caused by multidrug-resistant pathogens. Although pancreatic injury observed after tigecycline initiation is relatively uncommon, it may adversely affect patient prognosis. Currently, clinical management mainly relies on post-treatment monitoring, and reliable tools for early risk prediction are lacking. This study aimed to develop and internally validate an interpretable machine learning model for predicting pancreatic injury observed after tigecycline initiation using real-world clinical data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective study included patients who received tigecycline for at least 3 consecutive days at Nanfang Hospital, Southern Medical University, between January 2020 and March 2024. The primary outcome was pancreatic injury observed after tigecycline initiation, defined as serum amylase &amp;gt;405U\/L and\/or serum lipase &amp;gt;180 U\/L within 7 days after tigecycline initiation. Demographic characteristics, comorbidities, concomitant medications, tigecycline treatment information, and baseline laboratory parameters were collected. Missing values were imputed using K-nearest neighbors imputation, and class imbalance was addressed using SMOTE. The dataset was randomly divided into training and test sets at an 8:2 ratio. Eight machine learning algorithms were developed and compared. Model performance was evaluated using AUC, accuracy, sensitivity, specificity, positive predictive value, negative predictive value and F1 score. SHAP analysis was used for model interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 623 patients were included, of whom 146 (23.4%) developed pancreatic injury. Among the evaluated algorithms, LightGBM had the highest point-estimate AUC. The final 7-feature LightGBM model achieved an AUC of 0.726, accuracy of 0.728, sensitivity of 0.379, specificity of 0.833, PPV of 0.407, NPV of 0.816, and F1 score of 0.393 on the held-out test set. These results indicate moderate discrimination but limited sensitivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>With relatively high specificity and negative predictive value, this model may provide preliminary risk stratification information and assist targeted pancreatic enzyme monitoring during tigecycline therapy, particularly for identifying patients at lower predicted risk. However, prospective external validation is required before routine clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1930240","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:50:16Z","timestamp":1790661016000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of machine learning models for predicting pancreatic injury observed after tigecycline initiation: a retrospective real-world study"],"prefix":"10.3389","volume":"17","author":[{"given":"Fulong","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"Department of Pharmacy, Nanhai Guicheng Hospital","place":["Foshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangdong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunping","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liren","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1016\/j.cgh.2006.11.023","article-title":"Drug-induced acute pancreatitis: an evidence-based review","volume":"5","author":"Badalov","year":"2007","journal-title":"Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2538","DOI":"10.3748\/wjg.v30.i19.2538","article-title":"Non-pancreatic hyperlipasemia: a puzzling clinical entity","volume":"30","author":"Feher","year":"2024","journal-title":"World J. Gastroenterol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1980","DOI":"10.1093\/jac\/dkaf159","article-title":"Clinical characteristics and risk factors of tigecycline-induced acute pancreatitis in kidney transplant recipients: a retrospective study","volume":"80","author":"Feng","year":"2025","journal-title":"J. Antimicrob. Chemother."},{"key":"B4","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s12959-022-00369-z","article-title":"Coagulation dysfunction events associated with tigecycline: a real-world study from FDA adverse event reporting system (FAERS) database","volume":"20","author":"Guo","year":"2022","journal-title":"Thromb. J."},{"key":"B5","doi-asserted-by":"publisher","first-page":"e9","DOI":"10.1016\/j.jcf.2015.07.008","article-title":"Tigecycline-induced acute pancreatitis in a cystic fibrosis patient: a case report and literature review","volume":"15","author":"Hemphill","year":"2016","journal-title":"J. Cyst. Fibros. Off. J. Eur. Cyst. Fibros. Soc."},{"key":"B6","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1016\/j.ijantimicag.2009.05.004","article-title":"Tigecycline-induced acute pancreatitis: case report and literature review","volume":"34","author":"Hung","year":"2009","journal-title":"Int. J. Antimicrob. Agents"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.22207\/JPAM.18.3.22","article-title":"Burden of multidrug-resistant gram-negative bacterial infections in a tertiary care hospital","volume":"18","author":"Kavya","year":"2024","journal-title":"J. Pure Appl. Microbiol."},{"key":"B8","volume-title":"Lightgbm: A Highly Efficient Gradient Boosting Decision Tree","author":"Ke","year":"2017"},{"key":"B9","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1186\/s12879-018-3103-z","article-title":"Tigecycline-induced acute pancreatitis in a renal transplant patient: a case report and literature review","volume":"18","author":"Lin","year":"2018","journal-title":"BMC Infect. Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e0129450","DOI":"10.1371\/journal.pone.0129450","article-title":"Prognostic value of procalcitonin in adult patients with sepsis: a systematic review and meta-analysis","volume":"10","author":"Liu","year":"2015","journal-title":"PLOS One"},{"key":"B11","doi-asserted-by":"publisher","first-page":"292","DOI":"10.21037\/tau-20-959","article-title":"Efficacy and safety of tigecycline for complicated urinary tract infection: a systematic review","volume":"10","author":"Liu","year":"2021","journal-title":"Transl. Androl. Urol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"21","DOI":"10.3390\/epidemiologia6020021","article-title":"The global burden of multidrug-resistant bacteria","volume":"6","author":"Marino","year":"2025","journal-title":"Epidemiologia"},{"key":"B13","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1093\/jac\/dkt427","article-title":"Pancreatitis in tigecycline phase 3 and 4 clinical studies","volume":"69","author":"McGovern","year":"2014","journal-title":"J. Antimicrob. Chemother."},{"key":"B14","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.ijantimicag.2009.02.003","article-title":"Antimicrobial susceptibility of tigecycline and comparators against bacterial isolates collected as part of the TEST study in Europe (2004-2007)","volume":"34","author":"N\u00f8rskov-Lauritsen","year":"2009","journal-title":"Int. J. Antimicrob. Agents"},{"key":"B15","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1002\/phar.1159","article-title":"Tigecycline-related pancreatitis: a review of spontaneous adverse event reports","volume":"33","author":"Okon","year":"2013","journal-title":"Pharmacotherapy"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2971","DOI":"10.2147\/IJGM.S410542","article-title":"The spectrum of tigecycline-induced pancreatitis in clinical characteristics, diagnosis, and management","volume":"16","author":"Pan","year":"2023","journal-title":"Int. J. Gen. Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"103192","DOI":"10.1016\/j.eclinm.2025.103192","article-title":"An interpretable machine learning model based on optimal feature selection for identifying CT abnormalities in patients with mild traumatic brain injury","volume":"82","author":"Pan","year":"2025","journal-title":"Eclinicalmedicine"},{"key":"B18","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.pan.2024.11.021","article-title":"Three-tiered critical care management of acute pancreatitis","volume":"25","author":"P\u00e1zm\u00e1ny","year":"2025","journal-title":"Pancreatology"},{"key":"B19","doi-asserted-by":"publisher","first-page":"199903","DOI":"10.1109\/ACCESS.2025.3635541","article-title":"The impact of feature scaling in machine learning: effects on regression and classification tasks","volume":"13","author":"Pinheiro","year":"2025","journal-title":"IEEE Access"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e70056","DOI":"10.1111\/cts.70056","article-title":"Practical guide to SHAP analysis: explaining supervised machine learning model predictions in drug development","volume":"17","author":"Ponce-Bobadilla","year":"2024","journal-title":"Clin. Transl. Sci."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1342947","DOI":"10.3389\/fphar.2024.1342947","article-title":"Population pharmacokinetics and individualized dosing of tigecycline for critically ill patients: a prospective study with intensive sampling","volume":"15","author":"Su","year":"2024","journal-title":"Front. Pharmacol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"2788","DOI":"10.1111\/bcp.15776","article-title":"Clinical characteristics and risk factors for tigecycline-induced pancreatitis in a tertiary hospital: a retrospective study","volume":"89","author":"Tan","year":"2023","journal-title":"Br. J. Clin. Pharmacol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"419","DOI":"10.14309\/ajg.0000000000002645","article-title":"American college of gastroenterology guidelines: management of acute pancreatitis","volume":"119","author":"Tenner","year":"2024","journal-title":"Official Journal Am. Coll. Gastroenterology | ACG"},{"key":"B24","doi-asserted-by":"publisher","first-page":"318","DOI":"10.6002\/ect.2023.0227","article-title":"Tigecycline-associated hepatic steatosis after liver transplant: a case report","volume":"22","author":"Turan G\u00f6k\u00e7e","year":"2024","journal-title":"Exp. Clin. Transpl. Off. J. Middle East Soc. Organ Transpl."},{"key":"B25","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/S1473-3099(12)70323-7","article-title":"Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis","volume":"13","author":"Wacker","year":"2013","journal-title":"Lancet Infect. Dis."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e28245","DOI":"10.1097\/MD.0000000000028245","article-title":"Acute pancreatitis caused by tigecycline: a case report and literature review","volume":"100","author":"Wang","year":"2021","journal-title":"Medicine"},{"key":"B27","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1186\/s13059-021-02492-y","article-title":"LightGBM: accelerated genomically designed crop breeding through ensemble learning","volume":"22","author":"Yan","year":"2021","journal-title":"Genome Biol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e13593","DOI":"10.1111\/tid.13593","article-title":"A case report of tigecycline induced acute pancreatitis in a renal transplant patient and review of the literature: should we avoid tigecycline in patients on calcineurin inhibitors?","volume":"23","author":"Yazirli","year":"2021","journal-title":"Transpl. Infect. Dis. Off. J. Transpl. Soc."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1885","DOI":"10.2147\/DDDT.S365512","article-title":"Population pharmacokinetics of tigecycline: a systematic review","volume":"16","author":"Zhou","year":"2022","journal-title":"Drug Des. Dev. Ther."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1930240\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:50:17Z","timestamp":1790661017000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1930240\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":29,"alternative-id":["10.3389\/fphar.2026.1930240"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2026.1930240","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"article-number":"1930240"}}