title: Drug-related mortality among inpatients: a retrospective observational study.
abstract: OBJECTIVE
  Hospital mortality related to adverse drug reactions (ADRs) is a relevant clinical problem with major health and economic consequences. We conducted a study to assess hospital mortality related to ADRs, the drugs most frequently involved, and the possible risk factors associated with fatal ADRs.
  
  
  METHODS
  A retrospective observational study was conducted, reviewing the clinical records of 1388 consecutive adult patients (18-101 years) who died during a 22-month period in a tertiary hospital in Southern Europe (Granada, Spain). The main outcome was the prevalence of hospital death suspected to be related to administered drugs.
  
  
  RESULTS
  Out of the 1388 adult deaths studied, 256 (18.4 %) were suspected of being related to drugs. Drugs were suspected of causing death in 146 inpatients (10.5 %) and contributing to death in 110 (7.9 %). Drugs related to death were administered during the hospital stay in 161 cases (11.5 %) and before hospital admission in 95 (6.84 %). The most frequent fatal ADRs were cardiac arrhythmia, gastrointestinal bleeding, and respiratory failure. The drugs most frequently involved in fatal ADRs were antithrombotics (anticoagulants or antiplatelets) (23 %), psychotropic drugs (21.2 %), and digoxin (11.3 %). Independent risk factors for ADR-related death were the presence of ≥4 diseases (OR = 1.43) and the receipt of ≥10 drugs (OR = 3.24), but no significant association with gender or age was found.
  
  
  CONCLUSIONS
  A high percentage of hospital deaths were suspected of being associated with ADRs, especially in patients with comorbidity and/or polypharmacy. Antithrombotics, psychotropics, and digoxin were the drugs most frequently associated with in-hospital drug-related deaths.
authors.affiliation: Department of Internal Medicine, San Cecilio University Hospital, Avda. Dr. Olóriz n°16, 18012, Granada, Spain. apardoc05@yahoo.es.
authors.forename: Alfredo José
authors.initials: AJ
authors.lastname: Pardo Cabello
authors.affiliation: Department of Pharmacology, School of Medicine, Biomedical Research Institute ibs. Granada, University of Granada, Granada, Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Del Pozo Gavilán
authors.affiliation: Department of Medicine, School of Medicine, University of Granada, Granada, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Gómez Jiménez
authors.affiliation: School of Health Sciences of the University of Granada, Granada, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Mota Rodríguez
authors.affiliation: Department of Biostatistics, School of Medicine, University of Granada, Granada, Spain.
authors.forename: Juan de Dios
authors.initials: Jde D
authors.lastname: Luna Del Castillo
authors.affiliation: Clinical Pharmacology Unit of San Cecilio University Hospital, Granada, Spain.|Department of Pharmacology of School of Medicine, University of Granada, Granada, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Puche Cañas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004077:Digoxin / Q000009:adverse effects; D064420:Drug-Related Side Effects and Adverse Reactions / Q000401:mortality*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000009:adverse effects; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D011619:Psychotropic Drugs; D004077:Digoxin
keywords: Adverse drug reactions; Epidemiology; Hospital mortality; Inpatients