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Significant Medical Comorbidities Are Associated With Lower Causality Scores in Patients Presenting With Suspected Drug-Induced Liver Injury.

Publication ,  Journal Article
Ghabril, M; Gu, J; Yoder, L; Corbito, L; Dakhoul, L; Ringel, A; Beyer, CD; Vuppalanchi, R; Barnhart, H; Hayashi, PH; Chalasani, N
Published in: Clin Transl Gastroenterol
April 2020

INTRODUCTION: Drug-induced liver injury (DILI) is a diagnosis of exclusion, and it can be challenging to adjudicate when there are multiple comorbidities and concomitant medications. In this study, we tested the hypothesis that comorbidity burden impacts the causality adjudication in patients with suspected DILI. METHODS: We studied consecutive patients with suspected DILI enrolled in the Drug-Induced Liver Injury Network Prospective Study at 2 centers between 2003 and 2017. The comorbidity burden at presentation was determined using the Charlson Comorbidity Index (CCI). We analyzed the association between significant comorbidity (CCI > 75th percentile) and (i) the adjudication of DILI by expert consensus as definite, highly likely, or probable (high-confidence DILI) and (ii) the Roussel Uclaf Causality Assessment Method (RUCAM) scores. RESULTS: Our cohort consisted of 551 patients who were classified as "no comorbidity" (54%, CCI = 0), "mild comorbidity" (29%, CCI = 1 or 2), and "significant comorbidity" (17%, CCI > 2). The probability of high-confidence DILI was significantly lower in patients with significant comorbidity compared with those with mild or no comorbidities (67% vs 76% vs 87%, respectively, P < 0.001). The mean RUCAM scores decreased with increasing comorbidity (no comorbidity 6.6 ± 2, mild comorbidity 6 ± 2.4, and significant comorbidity 5.6 ± 2.7, P < 0.001). In the multiple logistic regression, significant comorbidity had an independent inverse relationship with DILI (odds ratio: 0.37, 95% confidence interval: 0.2-0.69, P = 0.001). DISCUSSION: Higher comorbidity burden impacts the causality assessment in patients with suspected DILI. Further studies are needed to investigate the utility of comorbidity burden as a variable in the DILI causality instruments.

Duke Scholars

Published In

Clin Transl Gastroenterol

DOI

EISSN

2155-384X

Publication Date

April 2020

Volume

11

Issue

4

Start / End Page

e00141

Location

United States

Related Subject Headings

  • Risk Factors
  • Prospective Studies
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Logistic Models
  • Liver
  • Humans
  • Female
  • Diagnosis, Differential
 

Citation

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Ghabril, M., Gu, J., Yoder, L., Corbito, L., Dakhoul, L., Ringel, A., … Chalasani, N. (2020). Significant Medical Comorbidities Are Associated With Lower Causality Scores in Patients Presenting With Suspected Drug-Induced Liver Injury. Clin Transl Gastroenterol, 11(4), e00141. https://doi.org/10.14309/ctg.0000000000000141
Ghabril, Marwan, Jiezhun Gu, Lindsay Yoder, Laura Corbito, Lara Dakhoul, Amit Ringel, Christian D. Beyer, et al. “Significant Medical Comorbidities Are Associated With Lower Causality Scores in Patients Presenting With Suspected Drug-Induced Liver Injury.Clin Transl Gastroenterol 11, no. 4 (April 2020): e00141. https://doi.org/10.14309/ctg.0000000000000141.
Ghabril M, Gu J, Yoder L, Corbito L, Dakhoul L, Ringel A, et al. Significant Medical Comorbidities Are Associated With Lower Causality Scores in Patients Presenting With Suspected Drug-Induced Liver Injury. Clin Transl Gastroenterol. 2020 Apr;11(4):e00141.
Ghabril, Marwan, et al. “Significant Medical Comorbidities Are Associated With Lower Causality Scores in Patients Presenting With Suspected Drug-Induced Liver Injury.Clin Transl Gastroenterol, vol. 11, no. 4, Apr. 2020, p. e00141. Pubmed, doi:10.14309/ctg.0000000000000141.
Ghabril M, Gu J, Yoder L, Corbito L, Dakhoul L, Ringel A, Beyer CD, Vuppalanchi R, Barnhart H, Hayashi PH, Chalasani N. Significant Medical Comorbidities Are Associated With Lower Causality Scores in Patients Presenting With Suspected Drug-Induced Liver Injury. Clin Transl Gastroenterol. 2020 Apr;11(4):e00141.

Published In

Clin Transl Gastroenterol

DOI

EISSN

2155-384X

Publication Date

April 2020

Volume

11

Issue

4

Start / End Page

e00141

Location

United States

Related Subject Headings

  • Risk Factors
  • Prospective Studies
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Logistic Models
  • Liver
  • Humans
  • Female
  • Diagnosis, Differential