dc.creator | Joseph, Merlyn | |
dc.creator | Brady, Rebecca | |
dc.creator | Attridge, Russell | |
dc.creator | Cota, Jason | |
dc.creator | Lusk, Kathleen | |
dc.creator | Attridge, Rebecca | |
dc.date.accessioned | 2019-05-14T19:50:16Z | |
dc.date.available | 2019-05-14T19:50:16Z | |
dc.date.issued | 2019-09-29 | |
dc.identifier.citation | Joseph, M., Brady, R., Attridge, R., Cota, J., Horlen, C., Lusk, K., & Attridge, R. L. (2018). Critically Ill Recipients of Weight-Based Fluconazole Meeting Drug-Induced Liver Injury Network Criteria. Hospital Pharmacy. https://doi.org/10.1177/0018578718802583 | en |
dc.identifier.uri | https://hdl.handle.net/1969.1/175358 | |
dc.description.abstract | Background: Fluconazole-associated liver injury is estimated to occur in <10% of patients; however, effect of weight-based fluconazole dosing on liver injury is unknown. Furthermore, no studies have systematically applied the Drug-Induced Liver Injury Network (DILIN) Criteria to identify patients who may have drug-induced liver injury in an intensive care unit (ICU) setting.
Objective: This study evaluated how often patients met DILIN criteria when receiving fluconazole daily doses of <6 mg/kg versus ⩾6 mg/kg. Methods: This dual-center, retrospective cohort study was performed in hospitalized critically ill fluconazole recipients. We compared liver function tests (LFTs) upon fluconazole initiation to peak LFTs within 2 weeks after discontinuation using DILIN criteria. The primary objective was to evaluate the number of patients meeting DILIN criteria when receiving fluconazole daily doses of <6 mg/kg versus ⩾6 mg/kg. Secondary objectives were to evaluate incidence of patients meeting DILIN criteria in patients with renal dysfunction, cirrhosis, septic shock, or those receiving a loading dose.
Results: Of 248 patients included, 90% had a documented fungal infection or received empiric therapy for suspected invasive candidiasis. In patients receiving <6 mg/kg of fluconazole, 55% (110/199) met DILIN criteria versus 46.9% (23/49) in the ⩾6 mg/kg cohort (P = .20). Only 14.5% of patients meeting DILIN criteria also met the definition for hepatocellular damage. Weight-based fluconazole dose and creatinine clearance <50 mL/min were not independent risk factors for meeting DILIN criteria. However, 77.3% of patients with cirrhosis met DILIN criteria (OR 4.84 [95% confidence interval, CI, 2.61-9.28]) and 76.3% with septic shock met DILIN criteria (OR 4.56 [95% CI, 2.44-8.88]).
Conclusion: Weight-based fluconazole dosing did not affect the number of critically ill recipients who met DILIN criteria. However, DILIN criteria may overestimate the incidence of fluconazole-associated liver injury in critically ill patients. | en |
dc.language.iso | en_US | |
dc.publisher | Hospital Pharmacy | |
dc.subject | DILIN | en |
dc.subject | fluconazole | en |
dc.subject | drug-induced liver injury network | en |
dc.subject | drug-induced liver injury | en |
dc.subject | hepatotoxicity | en |
dc.title | Critically Ill Recipients of Weight-Based Fluconazole Meeting Drug-Induced Liver Injury Network Criteria | en |
dc.type | Article | en |
local.department | Pharmacy Practice | en |
dc.identifier.doi | 10.1177/0018578718802583 | |