Hospital admissions attributed to adverse drug reactions in tertiary care in Uganda: burden and contributing factors.
Hospital admissions attributed to adverse drug reactions in tertiary care in Uganda: burden and contributing factors.
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DOI：
10.1177/20420986231188842
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发表时间：
2023
影响因子：
4.4
通讯作者：
Kiguba, Ronald
中科院分区：
文献类型：
--
作者：
Asio, Lillian;Nasasira, Marble;Kiguba, Ronald
关键词：
药物不良反应(ADR)在全球范围内加重了疾病负担，尤其令人关注的是与ADR相关的住院情况。这项研究试图确定不良反应的负担、特征、影响因素和患者结局，这些不良反应是乌干达住院患者入院的主要诊断。2013年11月至2014年4月，我们对乌干达穆拉戈国家转诊医院18岁及以上成年住院患者的前瞻性队列研究数据进行了横断面二次分析。我们回顾了临床图表，以确定住院患者有ADR作为入院诊断之一，如果是这样的话，入院是否主要归因于ADR。Logistic回归用于确定主要归因于不良反应的住院相关因素。在762名住院患者中，14%的患者在入院时出现了不良反应，7%的患者主要是因为不良反应而住院。所有住院患者共发生235例ADR，其中57%的ADR是与住院有关的主要诊断。大多数不良反应发生在艾滋病毒携带者身上，并被归因于抗逆转录病毒药物。HIV感染[AOR = 2.97，95%可信区间：1.30~6.77]、使用抗逆转录病毒治疗(AOR = 5.46，95%CI：2.56~11.68)、自我用药(AOR = 2.27，95%CI：1.14~4.55)和较多用药(AOR = 1.13，95%CI：1.01~1.26)是ADR的独立危险因素。抗逆转录病毒药物经常与ADR相关的住院病例有关。HIV感染(无论是否通过抗逆转录病毒治疗)、自我用药和高药片负担与ADR导致的住院有关。撒哈拉以南非洲的高艾滋病毒负担增加了与不良反应相关的住院风险，这意味着需要重视艾滋病毒携带者入院相关不良反应的早期发现、监测和适当管理。乌干达因药物不良反应入院的流行率和促成因素简介：药物不良反应(ADR)在世界许多地区是一个大问题，尤其值得关注的是患者主要是因为ADR而住院的情况。我们试图确定不良反应的负担、特征、致病因素和患者结局，这些不良反应是乌干达住院的主要诊断因素。方法：我们分析了从2013年11月至2014年4月在乌干达穆拉戈国家转诊医院对18岁及以上的成年住院患者进行的前瞻性队列研究收集的数据。我们回顾了临床图表，以确定ADR是入院诊断之一的住院患者，如果是这样的话，ADR是否是与入院相关的主要诊断。我们使用统计检验来评估可归因于不良反应的住院的影响因素。结果：在762例住院患者中，108例在入院时出现不良反应，56例主要是由于不良反应而入院。所有住院患者共发生235例不良反应，其中135例是与住院有关的主要诊断。大多数不良反应发生在艾滋病毒携带者身上，并与抗逆转录病毒药物有关。艾滋病毒感染、使用抗逆转录病毒治疗、自我用药和使用较多药物与住院主要归因于不良反应有关。结论：为了预防ADRs的入院，需要提醒患者不要自我用药，卫生工作者和患者需要提醒对HIV感染者(无论是否由ART管理)和服用多种药物的患者进行早期发现、监测和适当管理的重要性。
Adverse drug reactions (ADRs) contribute to the burden of disease globally and of particular concern are ADR-related hospital admissions. This study sought to determine the burden, characteristics, contributing factors and patient outcomes of ADRs that were the primary diagnosis linked to hospital admission among inpatients in Uganda. We conducted a cross-sectional secondary analysis of data from a prospective cohort study of adult inpatients aged 18 years and older at Uganda’s Mulago National Referral Hospital from November 2013 to April 2014. We reviewed clinical charts to identify inpatients with an ADR as one of the admitting diagnoses and, if so, whether or not the hospital admission was primarily attributed to the ADR. Logistic regression was used to determine factors associated with hospital admissions primarily attributed to ADRs. Among 762 inpatients, 14% had ADRs at hospital admission and 7% were primarily hospitalized due to ADRs. A total of 235 ADRs occurred among all inpatients and 57% of the ADRs were the primary diagnosis linked to hospital admission. The majority of ADRs occurred in people living with HIV and were attributed to antiretroviral drugs. HIV infection [aOR (adjusted odds ratio) = 2.97, 95% confidence interval (CI): 1.30–6.77], use of antiretroviral therapy (aOR = 5.46, 95% CI: 2.56–11.68), self-medication (aOR = 2.27, 95% CI: 1.14–4.55) and higher number of drugs used (aOR = 1.13, 95% CI: 1.01–1.26) were independently associated with hospital admissions attributed to ADRs. Antiretroviral drugs were often implicated in ADR-related hospital admissions. HIV infection (whether managed by antiretroviral therapy or not), self-medication and high pill burden were associated with hospital admissions attributable to ADRs. The high HIV burden in Sub-Saharan Africa increases the risk of ADR-related hospitalization implying the need for emphasis on early detection, monitoring and appropriate management of ADRs associated with hospital admission in people living with HIV. Prevalence and contributing factors of hospital admissions attributed to adverse drug reactions in Uganda Introduction: Adverse drug reactions (ADRs) are a big problem in many parts of the world and of particular concern is a situation where patients are admitted primarily because of an ADR. We sought to determine the burden, characteristics, contributing factors and patient outcomes of ADRs that were the primary diagnosis linked to hospital admission in Uganda. Methods: We analysed data collected from a prospective cohort study of adult inpatients aged 18 years and older at Uganda’s Mulago National Referral Hospital from November 2013 to April 2014. We reviewed clinical charts to identify inpatients in whom an ADR was one of the admitting diagnoses and, if so, whether or not the ADR was the primary diagnosis linked to hospital admission. We used statistical tests to assess for contributing factors of hospital admissions attributable to ADRs. Results: Among 762 inpatients, 108 had ADRs at admission and 56 were primarily admitted due to ADRs. A total of 235 ADRs occurred among all inpatients and 135 of the ADRs were the primary diagnosis linked to hospital admission. The majority of ADRs occurred in people living with HIV and were linked to antiretroviral drugs. HIV infection, use of antiretroviral therapy, self-medication and higher number of drugs used were associated with hospital admissions primarily attributed to ADRs. Conclusion: To prevent hospital admissions attributed to ADRs, patients need to be warned against self-medication, health workers and patients need to be reminded of the importance of early detection, monitoring and appropriate management of ADRs among the HIV-infected (whether managed by ART or not) and those patients taking many drugs.
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