Abstract
Purpose
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.
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Acknowledgments
The authors are grateful to Eloísa Casado Fernández MD and Carmen Laraño Díaz MD of the Clinical Documentation Department of San Cecilio University Hospital of Granada (Spain) and to Ana García Velasco and María Soriano Segura, research fellows of the School of Medicine of the University of Granada (Spain), for their participation in the gathering and coding of the data. The authors thank Richard Davies for improving the English style.
Authors contributions
Dr. AJ Pardo Cabello performed research, analyzed data and wrote the paper. Dr. E Del Pozo Gavilán performed research, analyzed data and wrote the paper. Dr. FJ Gómez Jiménez performed research, analyzed data and wrote the paper. Dr. C Mota Rodríguez performed research. Dr. JD Luna del Castillo analyzed data. Dr. E Puche Cañas conceived and designed study, performed research, analyzed data and wrote the paper.
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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee. Formal consent is not required for this retrospective study.
Funding
This study was funded by Department of Pharmacology (CP-2), University of Granada (Spain) in manuscript preparation.
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The authors declare that they have no conflict of interest.
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Pardo Cabello, A., Del Pozo Gavilán, E., Gómez Jiménez, F. et al. Drug-related mortality among inpatients: a retrospective observational study. Eur J Clin Pharmacol 72, 731–736 (2016). https://doi.org/10.1007/s00228-016-2026-0
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DOI: https://doi.org/10.1007/s00228-016-2026-0