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Evaluation of Drug-Induced Liver Injury Developed During Hospitalization Using Electronic Health Record (EHR)-Based Algorithm
Article in English | WPRIM | ID: wpr-811068
Responsible library: WPRO
ABSTRACT

PURPOSE:

The incidence of drug-induced liver injury (DILI) has been increasing; however, few algorithms are available to identify DILI in electronic health records (EHRs). We aimed to identify and evaluate DILI with an appropriate screening algorithm.

METHODS:

We collected data from 3 university hospitals between June 2015 and May 2016 using our newly developed algorithm for identifying DILI. Among patients with alanine transferase (ALT) ≤ 120 IU/L and total bilirubin (TB) ≤ 2.4 mg/dL in blood test results within 48 hours of admission, those who either had 1) ALT > 120 IU/L and TB > 2.4 mg/dL or 2) ALT > 200 IU/L at least once during hospitalization were identified. After excluding patients with liver disease-related diagnosis at discharge, medical records were retrospectively reviewed to evaluate epidemiological characteristics of DILI.

RESULTS:

The total number of inpatients was 256,598, of whom 1,100 (0.43%) were selected by the algorithm as suspected DILI. Subsequently, 365 cases (0.14% of total inpatients, 95% confidence interval, 0.13–0.16) were identified as DILI, yielding a positive predictive value of 33.1%. Antibiotics (n = 214, 47.2%) were the major class of causative drug followed by chemotherapeutic agents (n = 87, 19.2%). The most common causative drug was piperacillin-tazobactam (n = 38, 8.4%); the incidence of DILI by individual agent was highest for methotrexate (19.4 cases/1,000 patients administered the drug). Common reasons for excluding suspected DILI cases were ischemic hepatitis and postoperative liver dysfunction.

CONCLUSIONS:

Using our EHR-based algorithm, we identified that approximately 0.14% of patients developed DILI during hospitalization. Further studies are needed to modify criteria for more accurate identification of DILI.
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Transferases / Bilirubin / Humans / Mass Screening / Methotrexate / Medical Records / Incidence / Retrospective Studies / Pharmacoepidemiology / Diagnosis Type of study: Incidence study / Screening study Language: English Journal: Allergy, Asthma & Immunology Research Year: 2020 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Transferases / Bilirubin / Humans / Mass Screening / Methotrexate / Medical Records / Incidence / Retrospective Studies / Pharmacoepidemiology / Diagnosis Type of study: Incidence study / Screening study Language: English Journal: Allergy, Asthma & Immunology Research Year: 2020 Type: Article