Identification of Potential Drug-Disease Interactions in Hospitalized Patients with Liver Cirrhosis and the Prospective Utility of Clinical Decision Support Alerts

Abstract

BackgroundReal-world evidence on drug-disease interaction (DDSI) impact to hospitalized patients with liver cirrhosis is limited.ObjectiveA drug utilization review was performed to determine the prevalence of inappropriate drug use and potentially associated adverse drug events (ADEs) in these patients. Practical challenges regarding DDSI alert identification in clinical decision support systems (CDSS) were evaluated.MethodsIn this retrospective cohort study, a query analysis on the Minimal Hospital Data (MZG) database was performed identifying adult patients (>= 18 years) with a registered ICD-10 code for liver cirrhosis, admitted to a 721-bed Belgian university hospital (1 January 2019 to 31 December 2021). A randomly selected sample was evaluated. Additional data were collected from the electronic health record. Drug appropriateness evaluation was based on published recommendations. ADE causality analysis was performed by an expert panel.ResultsOut of 374 admissions, 100 individuals were selected (27%) using a median of 9 drugs per patient (IQR 6-14). Total prescription count for systemically administered drugs was 1059 (213 active substances), of which 99 (9%) were considered safe (12 active substances). Overall, 84 patients were exposed to potentially harmful drugs (159 prescriptions) during hospitalization. Three potential ADEs were identified. Patient parameters for the safety assessment were absent in 57% of cases, while 48% of drugs did not have any prescribing recommendations.ConclusionsHospitalized patients with liver cirrhosis are exposed to inappropriate drugs, potentially exacerbating their disease. Supporting prescribers in choosing the most adequate pharmacotherapy is essential but requires further adaptations of data documentation to effectively integrate CDSS.