A Tianjin real-world cohort study estimated that 12.17% of patients receiving immune checkpoint inhibitor therapy developed liver injury, with cholestatic injury most common. Investigators also reported that a neutrophil-to-lymphocyte ratio above 3 was linked to poorer liver-injury recovery within six months. The findings provide a benchmark for pharmacovigilance and patient monitoring, especially for clinicians weighing risk stratification strategies beyond trial populations. If validated, easily obtainable inflammatory markers could help guide surveillance intensity after initiation. For biotech and clinical operations, the study emphasizes that immune-related adverse event profiling must be monitored longitudinally in routine care, not only in controlled settings.