title: Life-threatening adverse drug reactions at admission to medical intensive care: a prospective study in a teaching hospital.
abstract: OBJECTIVE
  To assess the characteristics of life-threatening adverse drug reactions in patients admitted to medical intensive care unit and to define those that could facilitate early identification.
  
  
  METHODS
  A prospective 6-month observational study.
  
  
  METHODS
  Of the 436 admissions to the teaching hospital medical intensive care unit, all patients aged over 15 years and who had received documented drug treatment were included (n = 405).
  
  
  METHODS
  Characteristics of patients [age, gender, underlying diseases, organ failure(s), drugs taken, Severity Acute Physiologic Score II, length of stay, outcome at discharge] were prospectively collected using a standardised questionnaire. A panel of experts assessed putative serious adverse drug reaction(s) for each drug taken and each organ failure at admission by using a standardised causality assessment method. Characteristics of patients with and without serious adverse drug reactions at admission were compared using univariate and then stepwise descending multivariate logistic regression.
  
  
  RESULTS
  Of the 405 patients included, 111 (27.4%) presented an adverse drug reaction leading to organ failure. In 48% of cases adverse drug reactions were preventable, 23% were undiagnosed and 19% contributed to death. Age over 75 years [odds ratio (OR) 2.25; 95% confidence interval (CI) 1.15-4.38; p = 0.02], having more than three drugs (OR 6.90; 95% CI 1.44-33.00; p = 0.02) and a diagnosis of haematological malignancy (OR 6.19; 95% CI 2.07-18.53; p = 0.001) were independently associated with serious adverse drug reactions.
  
  
  CONCLUSIONS
  Preventable life-threatening adverse drug reactions were frequently involved in organ failure at admission to medical intensive care; many of them had not been identified.
authors.affiliation: Université Victor Segalen Bordeaux 2, INSERM U657, 146 rue Léo Saignat, 33075 Bordeaux cedex, France.
authors.forename: Marieke
authors.initials: M
authors.lastname: Grenouillet-Delacre
authors.forename: Hélène
authors.initials: H
authors.lastname: Verdoux
authors.forename: Nicholas
authors.initials: N
authors.lastname: Moore
authors.forename: Françoise
authors.initials: F
authors.lastname: Haramburu
authors.forename: Ghada
authors.initials: G
authors.lastname: Miremont-Salamé
authors.forename: Gabriel
authors.initials: G
authors.lastname: Etienne
authors.forename: Philip
authors.initials: P
authors.lastname: Robinson
authors.forename: Didier
authors.initials: D
authors.lastname: Gruson
authors.forename: Gilles
authors.initials: G
authors.lastname: Hilbert
authors.forename: Claude
authors.initials: C
authors.lastname: Gabinski
authors.forename: Bernard
authors.initials: B
authors.lastname: Bégaud
authors.forename: Mathieu
authors.initials: M
authors.lastname: Molimard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064420:Drug-Related Side Effects and Adverse Reactions / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D010343:Patient Admission; D011446:Prospective Studies; D011795:Surveys and Questionnaires