Utility of a Computerized ICD-10 Algorithm to Identify Idiosyncratic Drug-Induced Liver Injury Cases in the Electronic Medical Record
Open accessAbstract
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).Conclusion A computerized algorithm based on a combination of ICD-10 codes identified 182 potential DILI cases with 121 true positives, 61 false positives, and a positive predictive value of 66.5%. Future studies incorporating natural language processing may further improve the utility of this algorithm in identifying high-causality idiosyncratic DILI cases.
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The country with the highest percentage of DILI cases caused by paracetamol was the U.S.A at almost 30% followed by Pakistan at 16%.
“The country with the highest percentage of DILI cases caused by paracetamol was the U.S.A at almost 30% [217] followed by Pakistan at 16% [215].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [217]
Paracetamol accounted for a weighted mean of 7.3% (range 1.2-29.2%) of drug-induced liver injury (DILI).
“Overall, paracetamol accounted for a weighted mean of 55.7% (range 50.0-77.8%) of severe acute liver injury (ALI) and/or ALF [201-208] and 7.3% (range 1.2-29.2%) of drug-induced liver injury (DILI) [209-219] (see Figure 7).”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [217]
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- Authors
- Yeboah-Korang, A., Louissaint, J., Tsung, I., Prabhu, S., & Fontana, R. J.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Fontana, Robert J.
- Venue
- Drug Safety
- Published
- 2020-01-08
- Volume
- 43
- Issue
- 4
- Pages
- 371-377
- ISSN
- 0114-5916 (ISSN-L)
- 1179-1942
- PMC
- PMC8487619
- OpenAlex
- W2999821767
- Cited by
- 15
- References
- 29
- Citations by year
- 2026: 2 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 1
- FWCI
- 2.43
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Drug Safety (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK062708)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- idiosyncratic drug-induced liver injury, computerized algorithm, ICD-10 codes, electronic health records, RUCAM score, causality assessment, hepatotoxicity, anticancer agents, antibiotics, hepatocyte injury, positive predictive value, natural language processing
- MeSH terms
- Algorithms, Hospitalization, Humans, Liver Function Tests, Severity of Illness Index, United States, Databases, Factual, International Classification of Diseases, Chemical and Drug Induced Liver Injury, Electronic Health Records
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