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Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score
BACKGROUND: Drug-induced liver injury (DILI) represents an increasing morbidity in the general population, but more so in the elderly cohort of patients. Despite this, the concept of its prevention through prospective analysis has largely remained unexamined. We evaluated the utility of recently val...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489200/ https://www.ncbi.nlm.nih.gov/pubmed/32928134 http://dx.doi.org/10.1186/s12877-020-01732-3 |
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author | Danjuma, Mohammed Ibn-Mas’ud Almasri, Hussam Alshokri, Shaikha Khir, Fadi Khazahia Elmalik, Ashraf Battikh, Naim Ghazi Abdallah, Ibtihal Mahmoud Hassan Elshafei, Mohamed Fatima, Haajra Mohamed, Mouhand Faisal Hamad Maghoub, Yahya Hussain, Tanweer Kamal, Ijaz Anwer, Zubair Bidmos, Mubarak Ariyo Elzouki, Abdel-Naser |
author_facet | Danjuma, Mohammed Ibn-Mas’ud Almasri, Hussam Alshokri, Shaikha Khir, Fadi Khazahia Elmalik, Ashraf Battikh, Naim Ghazi Abdallah, Ibtihal Mahmoud Hassan Elshafei, Mohamed Fatima, Haajra Mohamed, Mouhand Faisal Hamad Maghoub, Yahya Hussain, Tanweer Kamal, Ijaz Anwer, Zubair Bidmos, Mubarak Ariyo Elzouki, Abdel-Naser |
author_sort | Danjuma, Mohammed Ibn-Mas’ud |
collection | PubMed |
description | BACKGROUND: Drug-induced liver injury (DILI) represents an increasing morbidity in the general population, but more so in the elderly cohort of patients. Despite this, the concept of its prevention through prospective analysis has largely remained unexamined. We evaluated the utility of recently validated adverse drug reactions (ADR) avoidability tool in a cohort of elderly patients with DILI. METHODS: We examined 38 DILI-drug pairs from n=38 patients in a prospective cohort of patients presenting with adverse drug reactions to a Weill Cornell-affiliated tertiary hospital between February 2019 and January 2020. DILI outcomes were adjudicated by the updated Roussel Uclaf Causality Assessment Method (RUCAM). Two clinical pharmacologists and two general physicians utilized the Liverpool adverse drug reactions avoidability tool (LAAT) and the modified Hallas tools to rate the preventability of DILI-drug pairs. Inter-rater, exact agreement proportions, as well as intraclass correlation coefficients were generated and expressed as ordinal outcomes. RESULTS: The cases examined for the determination of DILI avoidability had probability likelihood of “probable” or “highly probable” by the updated RUCAM scale. Examination of the 38 DILI-drug pairs (n= 38 patients) resulted in a total of 152 ordinal outcome decisions. We found about 32.3% (50/152) and 34.2% (52/152) of DILI-drug pairs were rated as “avoidable” (“probable” or “definite”) by the LAAT and the modified Hallas tools respectively. The overall median Krippendorf’s kappa with the LAAT was 0.61 (SE 0.12, CI 0.36, 0.85) and for modified Hallas tool was 0.53 (SE 0.18; CI 0.16, 0.89). The inter-rater correlation coefficient (ICC) for the LAAT and modified Hallas were 0.50 [0.32, 0.65] and 0.63 [0.48, 0.76] respectively. Exact pairwise agreement was present in 30/38 (IQR 29.5, 34.5), and 28/38 (IQR 27.5-35.5) of DILI-ADR pairs using the LAAT and modified Hallas tools respectively. CONCLUSION: We found a significant proportion of drug-induced liver injury adjudicated by the updated RUCAM scale in elderly hospitalized cohort of patients were avoidable with significant implication for therapeutic commissioning as well as cost effectiveness interventions in this cohort of patients. |
format | Online Article Text |
id | pubmed-7489200 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-74892002020-09-16 Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score Danjuma, Mohammed Ibn-Mas’ud Almasri, Hussam Alshokri, Shaikha Khir, Fadi Khazahia Elmalik, Ashraf Battikh, Naim Ghazi Abdallah, Ibtihal Mahmoud Hassan Elshafei, Mohamed Fatima, Haajra Mohamed, Mouhand Faisal Hamad Maghoub, Yahya Hussain, Tanweer Kamal, Ijaz Anwer, Zubair Bidmos, Mubarak Ariyo Elzouki, Abdel-Naser BMC Geriatr Research Article BACKGROUND: Drug-induced liver injury (DILI) represents an increasing morbidity in the general population, but more so in the elderly cohort of patients. Despite this, the concept of its prevention through prospective analysis has largely remained unexamined. We evaluated the utility of recently validated adverse drug reactions (ADR) avoidability tool in a cohort of elderly patients with DILI. METHODS: We examined 38 DILI-drug pairs from n=38 patients in a prospective cohort of patients presenting with adverse drug reactions to a Weill Cornell-affiliated tertiary hospital between February 2019 and January 2020. DILI outcomes were adjudicated by the updated Roussel Uclaf Causality Assessment Method (RUCAM). Two clinical pharmacologists and two general physicians utilized the Liverpool adverse drug reactions avoidability tool (LAAT) and the modified Hallas tools to rate the preventability of DILI-drug pairs. Inter-rater, exact agreement proportions, as well as intraclass correlation coefficients were generated and expressed as ordinal outcomes. RESULTS: The cases examined for the determination of DILI avoidability had probability likelihood of “probable” or “highly probable” by the updated RUCAM scale. Examination of the 38 DILI-drug pairs (n= 38 patients) resulted in a total of 152 ordinal outcome decisions. We found about 32.3% (50/152) and 34.2% (52/152) of DILI-drug pairs were rated as “avoidable” (“probable” or “definite”) by the LAAT and the modified Hallas tools respectively. The overall median Krippendorf’s kappa with the LAAT was 0.61 (SE 0.12, CI 0.36, 0.85) and for modified Hallas tool was 0.53 (SE 0.18; CI 0.16, 0.89). The inter-rater correlation coefficient (ICC) for the LAAT and modified Hallas were 0.50 [0.32, 0.65] and 0.63 [0.48, 0.76] respectively. Exact pairwise agreement was present in 30/38 (IQR 29.5, 34.5), and 28/38 (IQR 27.5-35.5) of DILI-ADR pairs using the LAAT and modified Hallas tools respectively. CONCLUSION: We found a significant proportion of drug-induced liver injury adjudicated by the updated RUCAM scale in elderly hospitalized cohort of patients were avoidable with significant implication for therapeutic commissioning as well as cost effectiveness interventions in this cohort of patients. BioMed Central 2020-09-14 /pmc/articles/PMC7489200/ /pubmed/32928134 http://dx.doi.org/10.1186/s12877-020-01732-3 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Danjuma, Mohammed Ibn-Mas’ud Almasri, Hussam Alshokri, Shaikha Khir, Fadi Khazahia Elmalik, Ashraf Battikh, Naim Ghazi Abdallah, Ibtihal Mahmoud Hassan Elshafei, Mohamed Fatima, Haajra Mohamed, Mouhand Faisal Hamad Maghoub, Yahya Hussain, Tanweer Kamal, Ijaz Anwer, Zubair Bidmos, Mubarak Ariyo Elzouki, Abdel-Naser Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score |
title | Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score |
title_full | Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score |
title_fullStr | Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score |
title_full_unstemmed | Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score |
title_short | Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score |
title_sort | avoidability of drug-induced liver injury (dili) in an elderly hospital cohort with cases assessed for causality by the updated rucam score |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489200/ https://www.ncbi.nlm.nih.gov/pubmed/32928134 http://dx.doi.org/10.1186/s12877-020-01732-3 |
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