Factors predisposing to serious adverse drug reactions in clinical practice among hospitalized patients

[N. Z. Petrović]

121 list

Uvod: Zbog svog potencijala da značajno povećaju morbiditet, smrtnost i ekonomsko opterećenje, ozbiljna neželjena dejstva (OND) lekova predstavljaju ozbiljan problem za javno zdravlje. Incidencija ozbiljnih neželjenih reakcija kreće se oko 6,7% kod hospitalizovanih pacijenata. Cilj je bio utvrditi faktore povezane sa pojavom OND lekova koji se javljaju u bolničkom okruženju, kao i identifikovati faktore, posebno grupe lekova, koji doprinose pojavi gastrointestinalnog dismotiliteta (GID). Metod: Ovo istraživanje je sprovedeno kroz dve studije. Prva je bila retrospektivnoprospektivna klinička opservaciona studija po tipu studije slučaj-kontrola. Druga studija je bila retrospektivna studija preseka. Odnos između nezavisnih, zbunjujućih faktora i ishoda istražen je multivarijantnom binarnom logističkom regresijom. Rezultati: U prvoj studiji je obuhvaćeno 147 hospitalizovanih pacijenata u UKCKG. Bilo je 49 pacijenata sa OND i 98 kontrola. Značajni faktori povezani sa OND lekova u studiji bili su ukupan broj konsultacija, Charlson-ov indeks komorbiditeta, Creaktivni protein, propisani antihistaminici, antihipertenzivi. Druga studija je obuhvatila 185 kritično obolelih pacijenata lečenih u jedinici intenzivnog lečenja UKCKG. Značajni faktori rizika povezani sa nekim oblikom GID bili su akutna bubrežna insuficijencija, nedavne operacije abdomena, mehanička ventilacija, starost, upotreba određenih lekova kao što su opioidi, antidepresivi i antidijabetici. Međutim, Charlson-ov indeks komorbiditeta je imao divergentan efekat u zavisnosti od oblika GID: povećavao je rizik od gastroezofagealnog refluksa, ali je štitio od ileusa, mučnine i povraćanja.

Introduction: Due to their potential to significantly increase morbidity, mortality, and economic burden, serious adverse drug reactions (SADRs) represent a major public health concern. The incidence of SADRs is approximately 6.7% among hospitalized patients. The aim of this study was to determine the factors associated with the occurrence of SADRs in a hospital setting and to identify specific contributing factors, particularly drug groups, that lead to the development of gastrointestinal dysmotility (GID). Method: This research was conducted through two studies. The first was a retrospectiveprospective clinical observational case-control study. The second study was a retrospective cross-sectional study. The relationship between independent and confounding factors and outcomes was analyzed using multivariate binary logistic regression. Results: The first study included 147 hospitalized patients at the University Clinical Center Kragujevac (UCCKG). There were 49 patients with SADRs and 98 controls. Significant factors associated with SADRs in the study included the total number of consultations, the Charlson Comorbidity Index, C-reactive protein, prescribed antihistamines, and antihypertensives. The second study included 185 critically ill patients treated in the intensive care unit of UCCKG. Significant risk factors associated with some form of GID included acute kidney injury, recent abdominal surgery, mechanical ventilation, advanced age, and the use of certain drugs such as opioids, antidepressants, and antidiabetics. However, the Charlson Comorbidity Index had a divergent effect depending on the type of GID: it increased the risk of gastroesophageal reflux disease but was protective against ileus, nausea, and vomiting. Conclusion: The identified risk factors can be implemented in clinical practice as an important supplementary element in the prevention of SADRs and GID.

ozbiljna neželjena dejstva, faktori rizika, lekovi, polifarmacija, gastrointestinalni dismotilitet, ileus, mučnina, povraćanje, Charlson-ov indeks komorbiditeta

serious adverse drug reactions, risk factors, drugs, polypharmacy, gastrointestinal dysmotility, ileus, nausea, vomiting, Charlson Comorbidity Index.

615.2:615.065(043.3)

Farmakologija

Tekst