Dahmke Hendrike, Schelshorn Jana, Fiumefreddo Rico, Schuetz Philipp, Salili Ali Reza, Cabrera-Diaz Francisco, Meyer-Massetti Carla, Zaugg Claudia
Hospital Pharmacy, Kantonsspital Aarau AG, Aarau, Switzerland.
Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
Drugs Real World Outcomes. 2024 Mar;11(1):125-135. doi: 10.1007/s40801-023-00405-y. Epub 2024 Jan 6.
The term triple whammy (TW) refers to the concomitant use of non-steroidal anti-inflammatory drugs, diuretics, and angiotensin system inhibitors; this combination significantly increases the risk of acute kidney injury (AKI). To prevent this serious complication, we developed an electronic algorithm that detects TW prescriptions in patients with additional risk factors such as old age and impaired kidney function. The algorithm alerts a clinical pharmacist who then evaluates and forwards the alert to the prescribing physician.
We evaluated the performance of this algorithm in a retrospective observational study of clinical data from all adult patients admitted to the Cantonal Hospital of Aarau in Switzerland in 2021. We identified all patients who received a TW prescription, had a TW alert, or developed AKI during TW therapy. Algorithm performance was evaluated by calculating the sensitivity and specificity as a primary endpoint and determining the acceptance rate among clinical pharmacists and physicians as a secondary endpoint.
Among 21,332 hospitalized patients, 290 patients had a TW prescription, of which 12 patients experienced AKI. Overall, 216 patients were detected by the alert algorithm, including 11 of 12 patients with AKI; the algorithm sensitivity is 88.3% with a specificity of 99.7%. Physician acceptance was high (77.7%), but clinical pharmacists were reluctant to forward the alerts to prescribers in some cases.
The TW algorithm is highly sensitive and specific in identifying patients with TW therapy at risk for AKI. The algorithm may help to prevent AKI in TW patients in the future.
“三重打击”（TW）一词指的是同时使用非甾体类抗炎药、利尿剂和血管紧张素系统抑制剂；这种联合使用会显著增加急性肾损伤（AKI）的风险。为预防这一严重并发症，我们开发了一种电子算法，用于检测存在老年和肾功能受损等额外风险因素的患者中的TW处方。该算法会向临床药师发出警报，然后临床药师对警报进行评估并转发给开处方的医生。
我们在一项回顾性观察研究中评估了该算法的性能，该研究分析了2021年瑞士阿劳州立医院收治的所有成年患者的临床数据。我们确定了所有接受TW处方、收到TW警报或在TW治疗期间发生AKI的患者。通过计算灵敏度和特异度作为主要终点来评估算法性能，并将临床药师和医生的接受率作为次要终点来确定。
在21332名住院患者中，290名患者有TW处方，其中12名患者发生了AKI。总体而言，警报算法检测到216名患者，包括12名发生AKI的患者中的11名；该算法的灵敏度为88.3%，特异度为99.7%。医生的接受度很高（77.7%），但临床药师在某些情况下不愿将警报转发给开处方的医生。
TW算法在识别有AKI风险的接受TW治疗的患者方面具有高度的灵敏度和特异度。该算法未来可能有助于预防TW患者发生AKI。
