Evaluation of Drug-Induced Liver Injury Developed During Hospitalization Using Electronic Health Record (EHR)-Based Algorithm
Allergy, Asthma & Immunology Research
; : 430-442, 2020.
Article
in English
| WPRIM (Western Pacific)
| 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.
Full text:
Available
Health context:
Sustainable Health Agenda for the Americas
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SDG3 - Target 3.3 End transmission of communicable diseases
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SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases
Health problem:
Goal 6: Information systems for health
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Hepatitis
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Digestive System Diseases
Database:
WPRIM (Western Pacific)
Main subject:
Transferases
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Bilirubin
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Mass Screening
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Methotrexate
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Medical Records
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Incidence
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Retrospective Studies
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Pharmacoepidemiology
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Diagnosis
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Alanine
Type of study:
Diagnostic study
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Incidence study
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Observational study
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Prognostic study
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Screening study
Limits:
Humans
Language:
English
Journal:
Allergy, Asthma & Immunology Research
Year:
2020
Document type:
Article