Allergy Asthma Immunol Res.  2020 May;12(3):430-442. 10.4168/aair.2020.12.3.430.

Evaluation of Drug-Induced Liver Injury Developed During Hospitalization Using Electronic Health Record (EHR)-Based Algorithm

• Kang Y
• Kim SH
• Park SY
• Park BY
• Lee JH
• An J
• Won HK
• Song WJ
• Kwon HS
• Cho YS
• Moon HB
• Shim JH
• Yang MS
• Kim TB

• KMID: 2471227
• DOI: http://doi.org/10.4168/aair.2020.12.3.430

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.

Keyword

Adverse drug reaction; algorithms; drug-induced liver injury; electronic health records; pharmacoepidemiology

MeSH Terms

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
Alanine
Anti-Bacterial Agents
Bilirubin
Methotrexate
Transferases

Figure

• 

  Fig. 1 Algorithm flowchart identifying DILI in the hospitalized patients.DILI, drug-induced liver injury; ALT, alanine transferase; UNL, upper limit of normal; TB, total bilirubin; EHR, electronic health record; RUCAM, Roussel Uclaf Causality Assessment Method.

• 

  Fig. 2 Causative drug class and individual agents.NSAID, nonsteroidal anti-inflammatory drug; TPN, total parenteral nutrition.

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