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Cited by 6

The DOI matches its Crossref record; 6 of the 6 references it cites were found in a registry or an index.

Improving the Diagnostic Accuracy of RECAM in North American Patients With Suspected Idiosyncratic Drug-Induced Liver Injury

Ciricillo, Jacob, Myer, Adam, Yeboah-Korang, Amoah, Osman, Askanda, Rahim, Farrah, Goldfarb, David G., Sharma, Yeshika, Louissaint, Jeremy, Sherman, Kenneth E., Fontana, Robert J.·2025·American Journal of Gastroenterology
DOI 10.14309/ajg.0000000000003147
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Abstract

INTRODUCTION: The Revised Electronic Causality Assessment Method (RECAM) is an updated, electronic version of the Roussel Uclaf Causality Assessment Method (RUCAM) to diagnose drug-induced liver injury (DILI). The primary aim of this study was to compare RECAM vs RUCAM in patients with suspected DILI. METHODS: Patient encounters from October 1, 2015, to September 30, 2019, were searched for suspected DILI using ICD-10 K71 codes for toxic liver disease. DILI Network (DILIN) expert opinion scores were assigned to each case (1/2/3 = probable DILI, 4/5 = non-DILI). RECAM and RUCAM scores were compared with DILIN expert opinion scores. RESULTS: Among 766,930 encounters searched, 120 unique patients met inclusion criteria with 72 (60%) adjudicated as probable-DILI. The most frequent suspect drugs were antimicrobials (38.3%), antineoplastics (8.3%), and antirheumatic drugs (8.3%). The mean age was 49.2 + 15.6 years, and 50% were female with 45.8% having hepatocellular injury. RUCAM had better agreement with DILIN expert opinion for probable-DILI vs RECAM (66.7% vs 44.4%, P = 0.018). Both had 100% agreement with DILIN expert opinion for non-DILI. Frequently missing laboratory data included hepatitis C virus (HCV) RNA (64.3%) and antihepatitis E virus (HEV) immunoglobulin M (IgM) testing (70%), leading to loss of up to 6 points in RECAM scoring but not affecting RUCAM scores. A modified RECAM that made HCV RNA and anti-HEV IgM optional had better agreement with DILIN expert opinion compared with RUCAM (79.2% vs 66.7%, P = 0.09). DISCUSSION: Among 120 suspected DILI cases, RUCAM had better agreement with DILIN expert opinion scores vs RECAM. Making HCV RNA and anti-HEV IgM testing optional significantly improved agreement between RECAM and DILIN expert opinion. Future modifications to RECAM are needed to improve causality assessment in North American patients with suspected DILI.

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Crossref · 10.14309/ajg.0000000000003147

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Citations

Cites

Research works printed but not linked: 22

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  3. Hayashi, 2009, Causality assessment in drug-induced liver injury, Semin Liver Dis, 29, 348, 10.1055/s-0029-1240003 · DOI
  4. Rockey, 2010, Causality assessment in drug-induced liver injury using a structured expert opinion process: Comparison to the roussel UCLAF causality assessment method, Hepatology, 51, 2117, 10.1002/hep.23577 · DOI · Paper page
  5. Lewis, 2014, Causality assessment: Which is best–expert opinion or RUCAM? clinical liver disease., Clin Liver Dis., 4, 4, 10.1002/cld.365 · DOI
  6. Hayashi, 2022, Recam: A new and improved, computerized causality assessment tool for DILI diagnosis, Am J Gastroenterol, 117, 1387, 10.14309/ajg.0000000000001836 · DOI · Paper page
  7. Fontana, 2009, Drug-induced liver injury network (DILIN) prospective study: Rationale, design and conduct, Drug Saf, 32, 55, 10.2165/00002018-200932010-00005 · DOI · Paper page
  8. Edlin, 2015, Toward a more accurate estimate of the prevalence of hepatitis C in the United States, Hepatology, 62, 1353, 10.1002/hep.27978 · DOI
  9. Zibbell, 2018, Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014, Am J Public Health, 108, 175, 10.2105/AJPH.2017.304132 · DOI
  10. Ryerson, 2020, Vital signs: Newly reported acute and chronic hepatitis C cases–United States, 2009-2018, MMWR Morb Mortal Wkly Rep, 69, 399, 10.15585/mmwr.mm6914a2 · DOI
  11. Hatia, 2015, Nosocomial hepatitis C virus transmission from tampering with injectable anesthetic opioids, Hepatology, 62, 101, 10.1002/hep.27800 · DOI
  12. Ahmad, 2019, Importance of hepatitis C virus RNA testing in patients with suspected drug induced liver injury, Dig Dis Sci, 64, 3645, 10.1007/s10620-019-05591-w · DOI
  13. Chalasani, 2021, ACG clinical guideline: Diagnosis and management of idiosyncratic drug-induced liver injury, Am J Gastroenterol, 116, 878, 10.14309/ajg.0000000000001259 · DOI · Paper page
  14. Ditah, 2014, Current epidemiology of hepatitis E virus infection in the US: Low seroprevalence in the national health and nutrition evaluation survey, Hepatology, 60, 815, 10.1002/hep.27219 · DOI
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  16. Fontana, 2022, Incidence of Hepatitis E infection in American patients with suspected drug-induced liver injury is low and declining: The DILIN prospective study, Am J Gastroenterol, 117, 1462, 10.14309/ajg.0000000000001869 · DOI
  17. Fontana, 2020, Role of hepatitis E virus infection in North American patients with severe acute liver injury, Clin translational Gastroenterol, 11, e00273, 10.14309/ctg.0000000000000273 · DOI · Paper page
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Metadata

Authors
Ciricillo, J., Myer, A., Yeboah-Korang, A., Osman, A., Rahim, F., Goldfarb, D. G., Sharma, Y., Louissaint, J., Sherman, K. E., & Fontana, R. J.
Affiliations
  • Division of Digestive Diseases, University of Cincinnati Medical Center, Cincinnati, Ohio, USA;
  • Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Brooklyn, New York, USA;
  • Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA;
  • Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, Michigan, USA.
ORCID
Venue
American Journal of Gastroenterology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2024-10-18
Volume
120
Issue
6
Pages
1325-1333
ISSN
  • 0002-9270
  • 1572-0241
DOI
10.14309/ajg.0000000000003147
Cited by
6
References
6
Language
en
Funders
American Association for the Study of Liver Diseases (2018 AASLD Foundation Advanced/Transplant Hepatology Grant)

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