Prior drug allergies are associated with worse outcome in patients with idiosyncratic drug-induced liver injury: A machine learning approach for risk stratification

医学 内科学 药品 置信区间 队列 逻辑回归 肝损伤 药物过敏 优势比 罪魁祸首 过敏 免疫学 药理学 心肌梗塞
作者
Hao Niu,Pablo Solís‐Muñoz,Miren García‐Cortés,Judith Sanabria‐Cabrera,Mercedes Robles‐Díaz,Rocío Romero-Flores,Elvira Bonilla‐Toyos,Aida Ortega‐Alonso,José M. Pinazo-Bandera,María R. Cabello,Fernando Bessone,Nelia Hernández,M. Isabel Lucena,Raúl J. Andrade,Inmaculada Medina‐Cáliz,Ismael Álvarez‐Álvarez
出处
期刊:Pharmacological Research [Elsevier BV]
卷期号:199: 107030-107030 被引量:2
标识
DOI:10.1016/j.phrs.2023.107030
摘要

The impact of prior drug allergies (PDA) on the clinical features and outcomes of patients who develop idiosyncratic drug-induced liver injury (DILI) is largely unknown. We aimed to assess the clinical presentation and outcomes of DILI patients based on the presence or absence of PDA and explore the association between culprit drugs responsible for DILI and allergy. We analysed a well-vetted cohort of DILI cases enrolled from the Spanish DILI Registry. Bootstrap-enhanced least absolute shrinkage operator procedure was used in variable selection, and a multivariable logistic model was fitted to predict poor outcomes in DILI. Of 912 cases with a first episode of DILI, 61 (6.7%) had documented PDA. Patients with PDA were older (p = 0.009), had higher aspartate aminotransferase (AST) levels (p = 0.047), lower platelet count (p = 0.011) and higher liver-related mortality than those without a history of drug allergies (11% vs. 1.6%, p < 0.001). Penicillin was the most common drug associated with PDA in DILI patients (32%). A model including PDA, nR-based type of liver injury, female sex, AST, total bilirubin, and platelet count showed an excellent performance in predicting poor outcome in patients from the Spanish DILI Registry (area under the ROC curve [AUC] 0.887; 95% confidence interval [CI] 0.794 - 0.981) and the LATINDILI Network (AUC 0.932; 95% CI 0.884 - 0.981). Patients with suspected DILI should be screened for PDA as they would require a close monitoring for early detection of worsening clinical course.
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