Please use this identifier to cite or link to this item: http://hdl.handle.net/10668/1859
Título : Use of Hy's law and a new composite algorithm to predict acute liver failure in patients with drug-induced liver injury.
Autor : Robles-Díaz, Mercedes
Lucena, M Isabel
Kaplowitz, Neil
Stephens, Camilla
Medina-Cáliz, Inmaculada
González-Jiménez, Andrés
Ulzurrun, Eugenia
González, Ana F
Fernández, M Carmen
Romero-Gómez, Manuel
Jiménez-Pérez, Miguel
Bruguera, Miguel
Prieto, Martín
Bessone, Fernando
Hernández, Nelia
Arrese, Marco
Andrade, Raúl J
Filiación: [Robles-Díaz, M; Lucena, MI; Stephens, C; Medina-Cáliz, I; González-Jiménez, A; Ulzurrun, E; González, AF; Andrade, RJ] Unidad de Gestión Clínica de Enfermedades Digestivas, Servicio de Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Málaga, Spain. [Robles-Díaz, M; Lucena, MI; Stephens, C; Medina-Cáliz, I; Ulzurrun, E; Romero-Gómez, M; Bruguera, M; Prieto, M; Andrade, RJ] Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain. [Kaplowitz, N] University of Southern California Research Center for Liver Diseases, Keck School of Medicine, Los Angeles, CA, United States. [Fernandez, MC] Servicio de Farmacia, Hospital de Torrecardenas, Almería, Spain. [ Romero-Gómez, M] Unidad de Gestión Clínica de Enfermedades Digestivas, Hospital Universitario de Valme, Sevilla, Spain. [Jiménez-Pérez, M] Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario Carlos Haya, Málaga, Spain. [Bruguera, M] Instituto de Enfermedades Digestivas y Metabolismo, Hospital Clinic, Barcelona, Spain. [Prieto, M] Unidad de Gestión Clínica de Enfermedades Digestivas, Hospital la Fe, Valencia, Spain. [Bessone, F] Facultad de Ciencias Médicas, Servicio de Gastroenterología y Hepatología, Hospital Provincial del Centenario, Rosario, Argentina. [Hernández, N] Hospital de Clínicas Clínica de Gastroenterología, Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay.
Palabras clave : Idiosyncratic Hepatotoxicity
Prognostic Risk Factor
Prediction
Progression
Comorbilidad
Enfermedad hepática inducida por drogas
Ictericia
Fallo hepático agudo
Valor predictivo de las pruebas
Factores de riesgo
Sensibilidad y especificidad
Factores sexuales
Alanina transaminasa
Algoritmos
Bilirrubina
Marcadores biológicos
Niños
MeSH: Medical Subject Headings::Named Groups::Persons::Age Groups::Adult
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged::Aged, 80 and over
Medical Subject Headings::Chemicals and Drugs::Enzymes and Coenzymes::Enzymes::Transferases::Nitrogenous Group Transferases::Transaminases::Alanine Transaminase
Medical Subject Headings::Information Science::Information Science::Computing Methodologies::Algorithms
Medical Subject Headings::Chemicals and Drugs::Enzymes and Coenzymes::Enzymes::Hydrolases::Esterases::Phosphoric Monoester Hydrolases::Alkaline Phosphatase
Medical Subject Headings::Chemicals and Drugs::Enzymes and Coenzymes::Enzymes::Transferases::Nitrogenous Group Transferases::Transaminases::Aspartate Aminotransferases
Medical Subject Headings::Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 1-Ring::Azoles::Pyrroles::Tetrapyrroles::Bile Pigments::Bilirubin
Medical Subject Headings::Chemicals and Drugs::Biological Factors::Biological Markers
Medical Subject Headings::Named Groups::Persons::Age Groups::Child
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Epidemiologic Factors::Comorbidity
Medical Subject Headings::Diseases::Digestive System Diseases::Liver Diseases::Drug-Induced Liver Injury
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hyperbilirubinemia::Jaundice
Medical Subject Headings::Diseases::Digestive System Diseases::Liver Diseases::Hepatic Insufficiency::Liver Failure::Liver Failure, Acute
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle Aged
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Models, Statistical
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Epidemiologic Research Design::Sensitivity and Specificity::Predictive Value of Tests
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Case-Control Studies::Retrospective Studies
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Statistics as Topic::Sensitivity and Specificity
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Epidemiologic Factors::Sex Factors
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Young Adult
Medical Subject Headings::Named Groups::Persons::Age Groups::Adolescent
Fecha de publicación : Jul-2014
Editorial : WB Saunders
Cita Bibliográfica: Robles-Diaz M, Lucena MI, Kaplowitz N, Stephens C, Medina-Cáliz I, González-Jimenez A, et al. Use of Hy's law and a new composite algorithm to predict acute liver failure in patients with drug-induced liver injury. Gastroenterology. 2014 ; 147(1):109-118.e5
Abstract: BACKGROUND & AIMS Hy's Law, which states that hepatocellular drug-induced liver injury (DILI) with jaundice indicates a serious reaction, is used widely to determine risk for acute liver failure (ALF). We aimed to optimize the definition of Hy's Law and to develop a model for predicting ALF in patients with DILI. METHODS We collected data from 771 patients with DILI (805 episodes) from the Spanish DILI registry, from April 1994 through August 2012. We analyzed data collected at DILI recognition and at the time of peak levels of alanine aminotransferase (ALT) and total bilirubin (TBL). RESULTS Of the 771 patients with DILI, 32 developed ALF. Hepatocellular injury, female sex, high levels of TBL, and a high ratio of aspartate aminotransferase (AST):ALT were independent risk factors for ALF. We compared 3 ways to use Hy's Law to predict which patients would develop ALF; all included TBL greater than 2-fold the upper limit of normal (×ULN) and either ALT level greater than 3 × ULN, a ratio (R) value (ALT × ULN/alkaline phosphatase × ULN) of 5 or greater, or a new ratio (nR) value (ALT or AST, whichever produced the highest ×ULN/ alkaline phosphatase × ULN value) of 5 or greater. At recognition of DILI, the R- and nR-based models identified patients who developed ALF with 67% and 63% specificity, respectively, whereas use of only ALT level identified them with 44% specificity. However, the level of ALT and the nR model each identified patients who developed ALF with 90% sensitivity, whereas the R criteria identified them with 83% sensitivity. An equal number of patients who did and did not develop ALF had alkaline phosphatase levels greater than 2 × ULN. An algorithm based on AST level greater than 17.3 × ULN, TBL greater than 6.6 × ULN, and AST:ALT greater than 1.5 identified patients who developed ALF with 82% specificity and 80% sensitivity. CONCLUSIONS When applied at DILI recognition, the nR criteria for Hy's Law provides the best balance of sensitivity and specificity whereas our new composite algorithm provides additional specificity in predicting the ultimate development of ALF.
Descripción : Journal Article;
URI: http://hdl.handle.net/10668/1859
Versión del editor : http://www.sciencedirect.com/science/article/pii/S0016508514004478
DOI: 10.1053/j.gastro.2014.03.050
ISSN : 1528-0012 (Online)
0016-5085 (Print)
Appears in Collections:01- Artículos - Hospital Regional de Málaga
01- Artículos - Hospital Virgen de la Victoria
01- Artículos - Complejo Hospitalario Torrecárdenas
01- Artículos - Hospital de Valme
01- Artículos - IBIMA. Instituto de Investigación Biomédica de Málaga

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