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How albumin administration for cirrhosis impacts on hospital albumin consumption and expenditure

World Journal of Gastroenterology 2011年第30期17卷 3479-3486页

作者： Federica Mirici-Cappa paolo caraceni Marco Domenicali Ernesto Gelonesi Barbara Benazzi Giacomo Zaccherini Franco Trevisani Cristina Puggioli Mauro Bernardi Department of Clinical Medicine Alma MaterS tudiorumUniversity of Bologna40126 BolognaItaly UO Pharmacology S Orsola-Malpighi University Hospital40138 BolognaItaly

AIM:To assess the impact of guidelines for albumin prescription in an academic hospital,which is a referral center for liver ***:Although randomized trials and guidelines support albumin administration for some complications of cirrhosis,the high cost of albumin greatly limits its use in clinical *** 2003,a multidisciplinary panel at Sant'Orsola-Malpighi University Hospital(Bologna,Italy)used a literature-based consensus method to list all the acute and chronic conditions for which albumin is indicated as first-or second-line *** in hepatology included prevention of post-paracentesis circulatory dysfunction and renal failure induced by spontaneous bacterial peritonitis,and treatment of hepatorenal syndrome and refractory *** still debated,albumin administration in refractory ascites is accepted by the Italian health care *** analyzedalbumin prescription and related costs before and after implementation of the new ***:While albumin consumption and costs doubled from 1998 to 2002,they dropped 20%after 2003,and remained stable for the following 6 *** of cirrhosis,namely refractory ascites and paracentesis,represented the predominant indications,followed by major surgery,shock,enteric diseases,and *** consumption increased significantly after guideline implementation in the liver units,whereas it declined elsewhere in the ***,extra-protocol albumin prescription was estimated as<10%.CONCLUSION:Albumin administration in cirrhosis according to international guidelines does not increase total hospital albumin consumption if its use in settings without evidence of efficacy is avoided.

关键词： Human serum albumin Cost analysis Livercirrhosis Critical illness Ascites

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Assessing liver injury associated with antimycotics:Concise literature review and clues from data mining of the FAERS database

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World Journal of Hepatology 2014年第8期6卷 601-612页

作者： Emanuel Raschi Elisabetta Poluzzi Ariola Koci paolo caraceni Fabrizio De Ponti Pharmacology Unit Department of Medical and Surgical SciencesAlma Mater StudiorumUniversity of Bologna I-40126 Bologna BO Italy

AIM: To inform clinicians on the level of hepatotoxicrisk among antimycotics in the post-marketing setting,following the marketing suspension of oral ketocon-azole for drug-induced liver injury(DILI).METHODS: The publicly available international FAERSdatabase(2004-2011) was used to extract DILI cases(including acute liver failure events), where antimycot-ics with systemic use or potential systemic absorptionwere reported as suspect or interacting agents. The re-porting pattern was analyzed by calculating the report-ing odds ratio and corresponding 95%CI, a measure ofdisproportionality, with time-trend analysis where ***: From 1687284 reports submitted over the8-year period, 68115 regarded liver injury. Of these,2.9% are related to antimycotics(1964 cases, of which 112 of acute liver failure). Eleven systemic antimycotics(including ketoconazole and the newer triazole deriva-tives voriconazole and posaconazole) and terbinafine(used systemically to treat onychomicosis) generated a significant disproportionality, indicating a post-market-ing signal of ***: Virtually all antimycotics with systemic action or absorption are commonly reported in clinically significant cases of DILI. Clinicians must be aware of this aspect and monitor patients in case switch is con-sidered, especially in critical poly-treated patients under chronic treatment.

关键词： Drug-induced hepatotoxicity Antimycotics Drug safety Pharmacovigilance Spontaneous reporting systems

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