BACKGROUND AND OBJECTIVE: While risk of acute kidney injury (AKI) is a well documented adverse effect of some drugs, few studies have assessed the relationship between drug-drug interactions (DDIs) and AKI. Our objective was to develop an algorithm capable of detecting potential signals on this relationship by retrospectively mining data from electronic health records. MATERIAL AND METHODS: Data were extracted from the clinical data warehouse (CDW) of the Hôpital Européen Georges Pompidou (HEGP). AKI was defined as the first level of the RIFLE criteria, that is, an increase ≥50 % of creatinine basis. Algorithm accuracy was tested on 20 single drugs, 10 nephrotoxic and 10 non-nephrotoxic. We then tested 45 pairs of non-nephrotoxic drugs, among the most prescribed at our hospital and representing distinct pharmacological classes for DDIs. RESULTS: Sensitivity and specificity were 50 % [95 % confidence interval (CI) 23.66-76.34] and 90 % (95 % CI 59.58-98.21), respectively, for single drugs. Our algorithm confirmed a previously identified signal concerning clarithromycin and calcium-channel blockers (unadjusted odds ratio (ORu) 2.92; 95 % CI 1.11-7.69, p = 0.04). Among the 45 drug pairs investigated, we identified a signal concerning 55 patients in association with bromazepam and hydroxyzine (ORu 1.66; 95 % CI 1.23-2.23). This signal was not confirmed after a chart review. Even so, AKI and co-prescription were confirmed for 96 % (95 % CI 88-99) and 88 % (95 % CI 76-94) of these patients, respectively. CONCLUSION: Data mining techniques on CDW can foster the detection of adverse drug reactions when drugs are used alone or in combination.
BACKGROUND AND OBJECTIVE: While risk of acute kidney injury (AKI) is a well documented adverse effect of some drugs, few studies have assessed the relationship between drug-drug interactions (DDIs) and AKI. Our objective was to develop an algorithm capable of detecting potential signals on this relationship by retrospectively mining data from electronic health records. MATERIAL AND METHODS: Data were extracted from the clinical data warehouse (CDW) of the Hôpital Européen Georges Pompidou (HEGP). AKI was defined as the first level of the RIFLE criteria, that is, an increase ≥50 % of creatinine basis. Algorithm accuracy was tested on 20 single drugs, 10 nephrotoxic and 10 non-nephrotoxic. We then tested 45 pairs of non-nephrotoxic drugs, among the most prescribed at our hospital and representing distinct pharmacological classes for DDIs. RESULTS: Sensitivity and specificity were 50 % [95 % confidence interval (CI) 23.66-76.34] and 90 % (95 % CI 59.58-98.21), respectively, for single drugs. Our algorithm confirmed a previously identified signal concerning clarithromycin and calcium-channel blockers (unadjusted odds ratio (ORu) 2.92; 95 % CI 1.11-7.69, p = 0.04). Among the 45 drug pairs investigated, we identified a signal concerning 55 patients in association with bromazepam and hydroxyzine (ORu 1.66; 95 % CI 1.23-2.23). This signal was not confirmed after a chart review. Even so, AKI and co-prescription were confirmed for 96 % (95 % CI 88-99) and 88 % (95 % CI 76-94) of these patients, respectively. CONCLUSION: Data mining techniques on CDW can foster the detection of adverse drug reactions when drugs are used alone or in combination.
Authors: Paul Avillach; Jean-Charles Dufour; Gayo Diallo; Francesco Salvo; Michel Joubert; Frantz Thiessard; Fleur Mougin; Gianluca Trifirò; Annie Fourrier-Réglat; Antoine Pariente; Marius Fieschi Journal: J Am Med Inform Assoc Date: 2012-11-29 Impact factor: 4.497
Authors: N P Tatonetti; J C Denny; S N Murphy; G H Fernald; G Krishnan; V Castro; P Yue; P S Tsao; P S Tsau; I Kohane; D M Roden; R B Altman Journal: Clin Pharmacol Ther Date: 2011-05-25 Impact factor: 6.875
Authors: Morgan B Slater; Andrea Gruneir; Paula A Rochon; Andrew W Howard; Gideon Koren; Christopher S Parshuram Journal: Paediatr Drugs Date: 2017-02 Impact factor: 3.022
Authors: Shawn N Murphy; Paul Avillach; Riccardo Bellazzi; Lori Phillips; Matteo Gabetta; Alal Eran; Michael T McDuffie; Isaac S Kohane Journal: PLoS One Date: 2017-04-07 Impact factor: 3.240