Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the
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RESEARCH ARTICLE
Open Access
Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score Mohammed Ibn-Mas’ud Danjuma1,2,3* , Hussam Almasri1, Shaikha Alshokri1,2, Fadi Khazahia Khir1, Ashraf Elmalik1, Naim Ghazi Battikh1, Ibtihal Mahmoud Hassan Abdallah1, Mohamed Elshafei1, Haajra Fatima1, Mouhand Faisal Hamad Mohamed1, Yahya Maghoub4, Tanweer Hussain1,5, Ijaz Kamal1, Zubair Anwer1, Mubarak Ariyo Bidmos3 and Abdel-Naser Elzouki1,2,3
Abstract 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. (Continued on next page)
* Correspondence: [email protected]; [email protected] 1 Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar 2 Weill Cornell College of Medicine, New York and Doha, Qatar Full list of author information is available at the end of the article
© The Author(s). 2020 Open Access This 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
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