Evaluation of Drug-Induced Liver Injury Developed During Hospitalization Using Electronic Health Record (EHR)-Based Algorithm
10.4168/aair.2020.12.3.430
- Author:
Yewon KANG
1
;
Sae Hoon KIM
;
So Young PARK
;
Bo Young PARK
;
Ji Hyang LEE
;
Jin AN
;
Ha Kyeong WON
;
Woo Jung SONG
;
Hyouk Soo KWON
;
You Sook CHO
;
Hee Bom MOON
;
Ju Hyun SHIM
;
Min Suk YANG
;
Tae Bum KIM
Author Information
1. Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. tbkim@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Adverse drug reaction;
algorithms;
drug-induced liver injury;
electronic health records;
pharmacoepidemiology
- MeSH:
Alanine;
Anti-Bacterial Agents;
Bilirubin;
Diagnosis;
Drug-Induced Liver Injury;
Drug-Related Side Effects and Adverse Reactions;
Electronic Health Records;
Hematologic Tests;
Hepatitis;
Hospitalization;
Hospitals, University;
Humans;
Incidence;
Inpatients;
Liver;
Liver Diseases;
Mass Screening;
Medical Records;
Methotrexate;
Pharmacoepidemiology;
Retrospective Studies;
Transferases
- From:Allergy, Asthma & Immunology Research
2020;12(3):430-442
- CountryRepublic of Korea
- Language:English
-
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.
