Utility of a Computerized ICD-10 Algorithm to Identify Idiosyncratic Drug-Induced Liver Injury Cases in the Electronic Medical Record

Abstract

Introduction-Idiosyncratic drug-induced liver injury (DILI) is an important cause of liver injury that is difficult to diagnose and identify in the electronic medical record (EMR).Objective-Our objective was to develop a computerized algorithm that can reliably identify DILI cases from the EMR. Methods-The EMR was searched for all encounters with an International Classification of Diseases, Tenth Revision (ICD-10) T code for drug toxicity and a K-71 code for toxic liver injury between 1 October 2015 and 30 September 2018. Clinically significant liver injury was defined using predetermined laboratory values. An expert opinion causality score (1-3 = probable DILI, 4/5 = non-DILI), Roussel Uclaf Causality Assessment Method (RUCAM) score, and severity score was assigned to each case.Results-Among the 1,211,787 encounters searched, 517 had both an ICD-10 T code and a K-71 code, with 257 patients meeting the laboratory criteria. After excluding 75 cases of acetaminophen hepatotoxicity, the final study sample included 182 cases of potential DILI, with antineoplastics and antibiotics being the most frequently implicated agents. Causality assessment identified probable DILI in 121 patients (66.5%), whereas 61 (33.5%) had an alternative cause of liver injury. Although age, sex, race, and suspect drugs were similar, the probable DILI cases were more likely to present with a hepatocellular injury profile and have more severe liver injury than the non-DILI cases (p < 0.05).

Drug Induced Liver Injury in Geriatric Patients Detected by a Two-Hospital Prospective Pharmacovigilance Program: A Comprehensive Analysis Using the Roussel Uclaf Causality Assessment Method

“…As with our study, previous studies, have identified that the predominant pattern in DILI is hepatocellular (53.29%) (Friis and Andreasen, 1992;Larrey, 2002;Sgro et al, 2002;Meier et al, 2005;De Valle et al, 2006;Xu et al, 2012;Yeboah-Korang et al, 2020). Other studies, have observed varied results for the pattern (Bagheri et al, 2000;Ibanez et al, 2002;Andrade et al, 2005;Onji et al, 2009;Bjornsson et al, 2013), with a predominance of the cholestatic pattern, which was also associated with older age, which is probably related to a delay in the diagnosis, given that the symptoms are less manifest in the elderly (Onji et al, 2009), a situation that is avoidable with proactive pharmacovigilance.…”

Landscape of DILI-related adverse drug reaction in China Mainland

“…Meanwhile, reports with key words of non-drug etiology, such as “viral liver disease”, “alcoholic liver disease”, and “autoimmune liver disease”, were excluded. It has been also reported to use keywords or the standardized codes to search adverse drug events from electronic medical records recently 17 . The complete searching key words and their translations used in this study were listed in Supporting Information Table S1 .…”

AASLD practice guidance on drug, herbal, and dietary supplement–induced liver injury

“…International Classification of Diseases, Tenth Revision codes and natural language processing algorithms may help identify DILI cases from administrative databases, but further refinement is needed. [208,209] In addition, improved understanding of the molecular pathogenesis of DILI is needed to minimize future morbidity and mortality and identify therapeutic targets for intervention.…”