Medication safety in patients with hepatic disease: proof of concept of a new approach to screen for patients at risk-a retrospective evaluation utilizing electronic prescribing systems.

introductionHepatic impairment (HI) leads to pharmacokinetic and pharmacodynamic changes demanding adjustment of drug therapy. To increase medication safety, hospital pharmacists need to quickly identify patients at risk. Laboratory parameters and liver scores are often available only with timely delay. Alternatively, screening for typical drugs used in severe HI in electronic prescribing systems could be an option.

aimTo test a new approach for the timely identification of patients with hepatic impairment. Drugs typically used in severe HI and its complications were evaluated as screening tools in patients with documented liver disease to identify patients who probably require drug adjustment to liver function.

methodPatients ≥ 18 years and hospitalized in the year 2022 with an ICD-10-GM coding for liver disease were identified retrospectively. ICD-10-GM classes of special interest, reflecting severe HI, were defined (K70 (alcoholic liver disease), K72 (hepatic failure) and K74 (liver fibrosis/cirrhosis)). Drugs typically used in severe hepatic impairment and its complications (index drugs) were defined as carvedilol, propranolol, lactulose, L-ornithin-L-aspartate, rifaximin, spironolactone and ursodeoxycholic acid. For all patients, use of index drugs according to the electronic prescribing system, laboratory liver parameters, MELD (Model of Endstage Liver Disease) and MELD 3.0 were documented. We analysed, how many patients and how many cases of hepatic ICD-10-GM-codes were identified by screening for index drugs.

resultOf 2319 patients with a hepatic ICD-10-GM-code in 2022, 2012 had electronic charts available. For these, 2916 main class ICD-10-GM codes were documented (4505 including main and sub-classes; median 1; IQR 1-3). Of 2012 patients, 1005 (50%) were treated with index drugs. Of the 2916 main ICD-10-GM classes, 1754 (60%) had index drugs, more often in codes of special interest (K74 82.5%, K70 79.7%, K72 68.9%). Patients in these main classes of special interest had higher MELD (median 14.8-18.2) and MELD 3.0 (18-22.9) compared to the overall patient cohort (MELD 12; MELD 3.0 15.9) and frequently laboratory liver parameters out of normal range.

conclusionScreening via index drugs typically used in hepatic impairment is a promising tool to identify patients at risk probably needing drug adjustment to hepatic function. Further studies need to determine the practical use of this tool to increase drug therapy safety.