Adverse-drug-event rates for high-cost and high-use drugs in the intensive care unit

Kane‐Gill, Sandra L.; Rea, Rhonda S.; Verrico, Margaret; Weber, Robert J.

doi:10.2146/ajhp060045

Cited by 44 publications

(27 citation statements)

References 31 publications

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“…Data on all patients admitted to an ICU at the University of Pittsburgh Medical Center from 2000 to 2008 are contained in HiDenIC-8. The medical center has an electronic data repository called the Medical Archival Repository System (MARS) 6,24,25 containing MARS-MediPAC (i.e. demographic, clinical, insurance data), MARS-Financial (i.e.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Acute Kidney Injury in Older Adults With Critical Illness: A Retrospective Cohort Study

Kane‐Gill

Sileanu

Murugan

et al. 2015

American Journal of Kidney Diseases

167

119

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Background Risk for acute kidney injury (AKI) in older adults has not been systematically evaluated. We sought to delineate the determinants of risk for AKI in older compared to younger adults. Study Design Retrospective analysis of patients hospitalized in July 2000–September 2008. Setting & Participants We identified all adult patients admitted to an intensive care unit (ICU) (n=45,655) in a large tertiary care university hospital system. We excluded patients receiving dialysis or kidney transplant prior to hospital admission, and patients with baseline creatinine ≥ 4 mg/dl, liver transplantation, indeterminate AKI status, or unknown age, leaving 39,938 patients. Predictor We collected data on multiple susceptibilities and exposures including age, sex, race, body mass, comorbid conditions, severity of illness, baseline kidney function, sepsis, and shock. Outcomes We defined AKI according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria. We examined susceptibilities and exposures across age strata for impact on development of AKI. Measurements We calculated area under the receiver operating characteristic curve (AUC) for prediction of AKI across age groups. Results 25,230 patients (63.2%) were aged 55 years or older. Overall 25,120 patients (62.9%) developed AKI (69.2% aged 55 years or older). Examples of risk factors for AKI in the oldest age category (75 years or older) were drugs (vancomycin, aminoglycosides, nonsteroidal anti-inflammatories), history of hypertension (OR, 1.13; 95% CI, 1.02–1.25) and sepsis (OR, 2.12; 95% CI, 1.68–2.67). Fewer variables remained predictive of AKI as age increased and the model for older patients was less predictive (p<0.001). For the age categories 18–54, 55–64, 65–74, and 75 years or older, the AUCs were 0.744 (95% CI, 0.735–0.752), 0.714 (95% CI, 0.702–0.726), 0.706 (95% CI, 0.693–0.718), and 0.673 (95% CI, 0.661–0.685), respectively. Limitations Analysis may not apply to non-ICU patients. Conclusions The likelihood of developing AKI increases with age; however the same variables are less predictive for AKI as age increases. Efforts to quantify risk for AKI may be more difficult in older adults.

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Section: Methodsmentioning

confidence: 99%

Risk Factors for Acute Kidney Injury in Older Adults With Critical Illness: A Retrospective Cohort Study

Kane‐Gill

Sileanu

Murugan

et al. 2015

American Journal of Kidney Diseases

167

119

View full text Add to dashboard Cite

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“…ADEs were identified using the University of Pittsburgh Medical Center-Presbyterian ADE database that has been in existence since 1994 to aid in satisfying regulatory requirements and for quality-improvement initiatives previously described (13). Adverse events involving blood products and nutritional products, if reported, were also included in this database.…”

Section: Methodsmentioning

confidence: 99%

Analysis of risk factors for adverse drug events in critically ill patients*

Kane‐Gill

Kirisci

Verrico

et al. 2012

Critical Care Medicine

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123

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Objectives An evaluation of risk factors for adverse drug events in critically ill patients has not been previously studied. The purpose of this original study was to determine risk factors for adverse drug events in critically ill adult patients. Design This retrospective case-control study includes patients who were admitted to the intensive care unit during a 7.5-yr period. Setting Academic medical center with 647 beds that contains approximately 120 intensive care unit beds. Patients Patients in the case group experienced an adverse drug event as documented in the hospital’s database. The control group comprised the next two patients admitted to the same intensive care unit by the same admitting service. Interventions None. Measurements and Main Results Twenty-nine suspected risk factors identified from the literature were evaluated, including patient characteristics, drug characteristics, and laboratory values using a multiple logistic regression. A sample of 1101 cases and controls (54% male), with a mean age of 59.4 ± 17.5 yrs, were identified. In 367 cases, there was a total of 499 documented adverse drug events. Patients with kidney injury, thrombocytopenia, and those admitted emergently were 16-times, 3-times, and 2-times more likely to have an adverse drug event, respectively. Patients who were administered intravenous medications had a 3% higher risk of having an adverse drug event for each drug dispensed. Overall, the case group received more drugs per intensive care unit day and more drugs per intensive care unit stay. Conclusions Several patient and drug-related characteristics contribute to the risk of adverse drug events in critically ill patients. Diligent monitoring of factors that can influence the pharmacokinetic properties for existing drug therapies is necessary. Drug regimens should be evaluated daily for minimization. Based on previous studies, pharmacists as part of the interdisciplinary team could help to manage these risks.

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“…Patients were identified, and data were obtained from the Medical Archival Retrieval System database, an electronic repository used for the health system that contains clinical and financial data used in prior studies [21,22]. From this severe alcohol withdrawal population, a manual chart review using an electronic health record (Powerchart; Cerner, Kansas City, MO) was conducted to identify patients meeting RAW criteria, consistent with the literature of a BZD equivalent of 40 mg of diazepam in 1 hour for management of AWS.…”

Section: Introductionmentioning

confidence: 99%

Multicenter evaluation of pharmacologic management and outcomes associated with severe resistant alcohol withdrawal

Wong¹,

Benedict²,

Kane‐Gill³

2015

Journal of Critical Care

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Adverse-drug-event rates for high-cost and high-use drugs in the intensive care unit

Cited by 44 publications

References 31 publications

Risk Factors for Acute Kidney Injury in Older Adults With Critical Illness: A Retrospective Cohort Study

Risk Factors for Acute Kidney Injury in Older Adults With Critical Illness: A Retrospective Cohort Study

Analysis of risk factors for adverse drug events in critically ill patients*

Multicenter evaluation of pharmacologic management and outcomes associated with severe resistant alcohol withdrawal

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