The adverse drug reaction risk in older persons (ADRROP) prediction scale: derivation and prospective validation of an ADR risk assessment tool in older multi-morbid patients
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Adverse drug reactions (ADRs) cause serious morbidity and mortality in multi-morbid older adults. Reliable ADR risk prediction would improve patient safety in this at-risk population. We aimed to derive and validate a new predictive tool for assessing ADR Risk in Older People (acronym ADRROP).
We combined four databases describing 2217 older people hospitalized with acute illness in order to determine risk factor variables significantly associated with ADRs. We identified the independent ADR risk factors from 1687 patients (derivation cohort) and used them to construct the ADRROP scale. We prospectively validated ADRROP using data from 530 patients (validation cohort). We applied area under the curve (AUC) analysis to test ADRROP’s ADR predictive power. We also compared ADRROP’s performance to the GerontoNet ADR risk scale.
Eight independent ADR risk factors were identified in the derivation patient cohort: female gender, age > 70 years, estimated GFR < 30 ml/min/1.73 m2, assistance required for ≥ 1 daily activity, ≥ 4 co-morbidities, liver disease, presence and number of STOPP criteria-defined potentially inappropriate medications, and ≥ 1 fall in the previous year. The ADRROP predictive scale constructed from these combined variables ranged from 0 to 27. The derivation cohort AUC value was 0.623 (95% CI 0.598–0.665); the validation cohort AUC was 0.592 (95% CI 0.532–0.652). Applying the GerontoNet ADR risk scale to the combined cohorts yielded an AUC of 0.566 (95% CI 0.537–0.596).
Conclusions and relevance
Neither ADRROP nor the GerontoNet ADR risk scale predicted ADRs to a high level in hospitalized older people with multi-morbidity.
KeywordsAdverse drug reactions (ADRs) Prevention Risk prediction Multi-morbidity Older people Polypharmacy
This research was supported by the SENATOR Project, funded by the European Commission under the Seventh Framework Programme (Grant Number 305930) and the Health Research Board of Ireland (Grant Number HRA_HSR/2010/14). The assistance of Dr. Darren Dahly, PhD, of the University College Cork Clinical Research Facility with the statistical analysis of the data is gratefully acknowledged.
Compliance with ethical standards
Conflict of interest
None of the authors reports a conflict of interest in relation to this manuscript.
Each of the 4 studies whose data constituted the database for the present study received approval from the Cork University Hospitals research ethics committee.
Each of the 4 ethically approved studies collected data on the basis of written informed consent from patients or their next-of-kin.
- 13.Lattanzio F, Laino I, Pedone C, Corica F, Maltese G, Salerno G, Garasto S, Corsonello A, Incalzi RA, PharmacosurVeillance in the elderly Care (PVC) Study Group (2012) Geriatric conditions and adverse drug reactions in elderly hospitalized patients. J Am Med Dir Assoc 13(2):96–99CrossRefPubMedGoogle Scholar
- 18.Dormann H, Sonst A, Müller F, Vogler R, Patapovas A, Pfistermeister B, Plank-Kiegele B, Kirchner M, Hartmann N, Bürkle T, Maas R (2013) Adverse drug events in older patients admitted as an emergency: the role of potentially inappropriate medication in elderly people (PRISCUS). Dtsch Arztebl Int 110(13):213–219PubMedPubMedCentralGoogle Scholar
- 20.Corsonello A, Pedone C, Corica F, Mussi C, Carbonin P, Antonelli Incalzi R, Gruppo Italiano di Farmacovigilanza nell’Anziano (GIFA) Investigators (2005) Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients. Arch Intern Med 165(7):790–795CrossRefPubMedGoogle Scholar
- 26.Stevenson JM, Williams JL, Burnham TG, Prevost AT, Schiff R, Erskine SD, Davies JG (2014) Predicting adverse drug reactions in older adults; a systematic review of the risk prediction models. Clin Investig Aging 9:1581–1593Google Scholar
- 28.Tangiisuran B, Scutt G, Stevenson J, Wright J, Onder G, Petrovic M, van der Cammen TJ, Rajkumar C, Davies G (2014) Development and validation of a risk model for predicting adverse drug reactions in older people during hospital stay: Brighton Adverse Drug Reactions Risk (BADRI) model. PLoS ONE 9(10):e111254CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Onder G, Petrovic M, Tangiisuran B, Meinardi MC, Markito-Notenboom WP, Somers A, Rajkumar C, Bernabei R, van der Cammen TJ (2010) Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older: the GerontoNet ADR risk score. Arch Intern Med 170(13):1142–1148CrossRefPubMedGoogle Scholar
- 31.Schneider EL, Campese VM (2010) Adverse drug responses: an increasing threat to the well-being of older patients: comment on “Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older”. Arch Intern Med 170(13):1148–1149CrossRefPubMedGoogle Scholar
- 32.World Health Organization technical report series, No. 498, p 9. http://apps.who.int/iris/bitstream/10665/40968/1/WHO_TRS_498.pdf. Accessed 2 Nov 2017
- 34.O’Sullivan D, O’Mahony D, O’Connor MN, Gallagher P, Gallagher J, Cullinan S, O’Sullivan R, Eustace J, Byrne S (2016) Prevention of adverse drug reactions in hospitalised older patients using a software-supported structured pharmacist intervention: a cluster randomised controlled trial. Drugs Aging 33(1):63–73CrossRefPubMedGoogle Scholar
- 35.O’Connor MN, O’Sullivan D, Gallagher PF, Eustace J, Byrne S, O’Mahony D (2016) Prevention of hospital-acquired adverse drug reactions in older people using screening tool of older persons’ prescriptions and screening tool to alert to right treatment criteria: a cluster randomized controlled trial. J Am Geriatr Soc 64(8):1558–1566CrossRefPubMedGoogle Scholar
- 37.Boeker EB, Ram K, Klopotowska JE, de Boer M, Creus MT, de Andrés AL, Sakuma M, Morimoto T, Boermeester MA, Dijkgraaf MG (2015) An individual patient data meta-analysis on factors associated with adverse drug events in surgical and non-surgical inpatients. Br J Clin Pharmacol 79(4):548–557CrossRefPubMedGoogle Scholar
- 38.O’Mahony D (2017) Optimizing pharmacotherapy for older patients. In: Michel J-P, Lynn Beattie B, Martin FC, Walston JD (eds) Oxford textbook of geriatric medicine, 3rd edn. Oxford University Press, Oxford, p 183–88Google Scholar
- 40.http://www.senator-project.eu/ accessed on November 2, 2017