Research Square · Oct 27, 2026

GLP-1 receptor agonists and pyogenic liver abscess risk in adults with type 2 diabetes mellitus

By Yang C, Li Y, Wu T et al.

Background Pyogenic liver abscess (PLA) is a potentially life-threatening hepatic infection, and diabetes mellitus is a well-established risk factor due to its immunosuppressive effects and association with poor glycemic control. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) exhibit anti-inflammatory and organ-protective properties and have been linked to reduced rates of several infections, yet their effect on intra-abdominal infections remains uncertain, and their known tendency to promote biliary disease raises a plausible mechanism by which they could instead increase PLA risk. The study aim to determine whether GLP-1RA use is associated with the incidence of PLA among adults with type 2 diabetes mellitus (T2DM). Methods This retrospective cohort study used the TriNetX US Collaborative Network. Adults aged ≥ 20 with newly diagnosed T2DM who initiated a GLP-1RA within 3 months of diagnosis were compared with a 1:1 propensity-score-matched cohort of non-users, balanced on demographics, comorbidities, body mass inedex, and HbA1c. The primary outcome was incident PLA which was assessed by Kaplan-Meier estimates and Cox proportional hazards models. Results After matching, 199154 patients were included in each group and baseline characteristics were well balanced. PLA occurred in 94 GLP-1RA users versus 103 non-users. GLP-1RA initiation was associated with a significantly lower risk of PLA (HR 0.70, 95% CI 0.53–0.93). Protective associations were consistent across subgroups aged 20–64 years, females, and White patients. Conclusions Among adults with newly diagnosed T2DM, GLP-1RA initiation was associated with a modestly reduced risk of pyogenic liver abscess compared with other glucose-lowering therapies. Confirmation in Asian populations, where PLA is more prevalent, is necessary.

doi.org/10.21203/rs.3.rs-11185901/v1Open accessInterventions