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在“我们所有人”研究计划中,常用抗生素导致的药物性肝损伤。

Drug-Induced Liver Injury with Commonly Used Antibiotics in the All of Us Research Program.

机构信息

Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA.

Sanford Imagenetics, Sioux Falls, South Dakota, USA.

出版信息

Clin Pharmacol Ther. 2023 Aug;114(2):404-412. doi: 10.1002/cpt.2930. Epub 2023 May 24.

Abstract

Antibiotics are a known cause of idiosyncratic drug-induced liver injury (DILI). According to the Centers for Disease Control and Prevention, the five most commonly prescribed antibiotics in the United States are azithromycin, ciprofloxacin, cephalexin, amoxicillin, and amoxicillin-clavulanate. We quantified the frequency of acute DILI for these common antibiotics in the All of Us Research Program, one of the largest electronic health record (EHR)-linked research cohorts in the United States. Retrospective analyses were conducted applying a standardized phenotyping algorithm to de-identified clinical data available in the All of Us database for 318,598 study participants. Between February 1984 and December 2022, more than 30% of All of Us participants (n = 119,812 individuals) had been exposed to at least 1 of our 5 study drugs. Initial screening identified 591 potential case patients that met our preselected laboratory-based phenotyping criteria. Because DILI is a diagnosis of exclusion, we then used phenome scanning to narrow the case counts by (i) scanning all EHRs to identify all alternative diagnostic explanations for the laboratory abnormalities, and (ii) leveraging International Classification of Disease 9th revision (ICD)-9 and ICD 10th revision (ICD)-10 codes as exclusion criteria to eliminate misclassification. Our final case counts were 30 DILI cases with amoxicillin-clavulanate, 24 cases with azithromycin, 24 cases with ciprofloxacin, 22 cases with amoxicillin alone, and < 20 cases with cephalexin. These findings demonstrate that data from EHR-linked research cohorts can be efficiently mined to identify DILI cases related to the use of common antibiotics.

摘要

抗生素是导致药物性肝损伤(DILI)的已知原因。根据疾病控制与预防中心的数据,美国最常开的五种抗生素是阿奇霉素、环丙沙星、头孢氨苄、阿莫西林和阿莫西林克拉维酸。我们在全美研究计划(All of Us Research Program)中对这些常用抗生素导致急性 DILI 的频率进行了量化,全美研究计划是美国最大的电子健康记录(EHR)相关研究队列之一。我们应用标准化的表型分析算法对全美研究计划数据库中可用于 318598 名研究参与者的去识别临床数据进行了回顾性分析。在 1984 年 2 月至 2022 年 12 月期间,超过 30%的全美研究计划参与者(n=119812 人)至少使用过我们 5 种研究药物中的 1 种。初始筛选确定了 591 例符合我们预先选定的基于实验室表型标准的潜在病例患者。由于 DILI 是一种排除性诊断,因此我们使用表型扫描技术来缩小病例计数,具体方法为:(i)扫描所有 EHR 以识别实验室异常的所有替代诊断解释;(ii)利用国际疾病分类第 9 版(ICD-9)和国际疾病分类第 10 版(ICD-10)代码作为排除标准,以消除误诊。我们最终确定了 30 例阿莫西林克拉维酸相关的 DILI 病例、24 例阿奇霉素相关的 DILI 病例、24 例环丙沙星相关的 DILI 病例、22 例阿莫西林相关的 DILI 病例和 <20 例头孢氨苄相关的 DILI 病例。这些发现表明,EHR 相关研究队列的数据可以被有效地挖掘,以识别与常用抗生素使用相关的 DILI 病例。

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