Allergy, Asthma & Respiratory Disease

The Korean Academy of Asthma, Allergy and Clinical Immunology (대한천식알레르기학회)
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Optimal methods to detect DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome by electronic medical records

전자의무기록을 이용한 DRESS (drug reaction with eosinophilia and systemic symptoms) 증후군 탐색

  • Kang, Dong Yoon (Drug Safety Monitoring Center, Seoul National University Hospital) ;
  • Jang, Dong Yeon (Seoul National University College of Medicine) ;
  • Sohn, Kyung Hee (Public Health Medical Service, Seoul National University Hospital) ;
  • Kang, Sung Yoon (Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Ju Young (Department of Internal Medicine, Gyeongsang National University Hospital) ;
  • Cho, Sang-Heon (Drug Safety Monitoring Center, Seoul National University Hospital) ;
  • Kang, Hye-Ryun (Drug Safety Monitoring Center, Seoul National University Hospital)
  • 강동윤 (서울대학교병원 약물유해반응관리센터) ;
  • 장동연 (서울대학교 의학대학원) ;
  • 손경희 (서울대학교병원 공공보건의료사업단) ;
  • 강성윤 (서울대학교 의과대학 내과학교실) ;
  • 김주영 (경상대학교병원 호흡기알레르기내과) ;
  • 조상헌 (서울대학교병원 약물유해반응관리센터) ;
  • 강혜련 (서울대학교병원 약물유해반응관리센터)
  • Received : 2017.09.07
  • Accepted : 2017.11.08
  • Published : 2018.05.31
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Abstract

Purpose: Since drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is very rare and difficult to diagnose, its exact epidemiology is still unknown. If screening tools based on laboratory results or electronic medical records are available, the occurrence of DRESS syndrome can be monitored in real time. Methods: To screen cases with DRESS syndrome, all the results of both eosinophil and alanine transaminase (ALT) level from July 2014 to June 2015 were analyzed by 36 searching conditions for the signal detection of 7 definite DRESS cases among 199,924 patients during the study period. Those searching conditions were diverse combinations of different cutoff levels of eosinophil and ALT with or without nursing records presenting skin symptoms. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated for individual searching conditions. Results: As cutoff levels of eosinophil and ALT for screening DRESS increased from 3% to 5% and 40 U/L to 300 U/L, respectively, the sensitivity decreased from 100% to 42.9% and the PPV increased from 0.06% to 13.0%. A combination of eosinophil > 10% and ALT > 300 U/L which had the highest PPV among 36 search conditions could detect DRESS syndrome by sensitivity 42.9% and PPV 13.0%. When nursing records for skin symptoms were added, PPV was augmented to 21.4%. Conclusion: A combination of eosinophil and ALT levels is a useful search condition for the screening of DRESS syndrome. Nursing records can provide an additional increment in PPV.

Keywords

References

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