title: Detection of Drug-Drug Interactions Inducing Acute Kidney Injury by Electronic Health Records Mining.
abstract: OBJECTIVE
  While risk of acute kidney injury (AKI) is a well documented adverse effect of some drugs, few studies have assessed the relationship between drug-drug interactions (DDIs) and AKI. Our objective was to develop an algorithm capable of detecting potential signals on this relationship by retrospectively mining data from electronic health records.
  
  
  METHODS
  Data were extracted from the clinical data warehouse (CDW) of the Hôpital Européen Georges Pompidou (HEGP). AKI was defined as the first level of the RIFLE criteria, that is, an increase ≥50 % of creatinine basis. Algorithm accuracy was tested on 20 single drugs, 10 nephrotoxic and 10 non-nephrotoxic. We then tested 45 pairs of non-nephrotoxic drugs, among the most prescribed at our hospital and representing distinct pharmacological classes for DDIs.
  
  
  RESULTS
  Sensitivity and specificity were 50 % [95 % confidence interval (CI) 23.66-76.34] and 90 % (95 % CI 59.58-98.21), respectively, for single drugs. Our algorithm confirmed a previously identified signal concerning clarithromycin and calcium-channel blockers (unadjusted odds ratio (ORu) 2.92; 95 % CI 1.11-7.69, p = 0.04). Among the 45 drug pairs investigated, we identified a signal concerning 55 patients in association with bromazepam and hydroxyzine (ORu 1.66; 95 % CI 1.23-2.23). This signal was not confirmed after a chart review. Even so, AKI and co-prescription were confirmed for 96 % (95 % CI 88-99) and 88 % (95 % CI 76-94) of these patients, respectively.
  
  
  CONCLUSIONS
  Data mining techniques on CDW can foster the detection of adverse drug reactions when drugs are used alone or in combination.
authors.affiliation: Biomedical Informatics and Public Health Department, HEGP, AP-HP, Paris, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Girardeau
authors.forename: Claire
authors.initials: C
authors.lastname: Trivin
authors.forename: Pierre
authors.initials: P
authors.lastname: Durieux
authors.forename: Christine
authors.initials: C
authors.lastname: Le Beller
authors.forename: Lillo-Le
authors.initials: LL
authors.lastname: Louet Agnes
authors.forename: Antoine
authors.initials: A
authors.lastname: Neuraz
authors.forename: Patrice
authors.initials: P
authors.lastname: Degoulet
authors.forename: Paul
authors.initials: P
authors.lastname: Avillach
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D057225:Data Mining / Q000379:methods*; D004347:Drug Interactions; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity