BACKGROUND The RECAM is an updated, electronic version of the RUCAM to diagnose DILI. The primary aim of this study was to compare RECAM versus RUCAM in patients with suspected DILI. METHODS Patient encounters from 10/1/2015 to 9/30/2019 were searched for suspected DILI using ICD-10 K71 codes for toxic liver disease. DILIN expert opinion scores were assigned to each case (1/2/3= probable DILI, 4/5= non-DILI). RECAM and RUCAM scores were compared with DILIN expert opinion scores. RESULTS Among 766,930 encounters searched, 120 unique patients met inclusion criteria with 72 (60%) adjudicated as probable-DILI. The most frequent suspect drugs were antimicrobials (38.3%), antineoplastics (8.3%), and antirheumatic drugs (8.3%). Mean age was 49.2 + 15.6 years and 50% were female with 45.8% having hepatocellular injury. RUCAM had better agreement with DILIN expert opinion for probable-DILI versus RECAM (66.7% vs. 44.4%, p=0.018). Both had 100% agreement with DILIN expert opinion for non-DILI. Frequently missing laboratory data included HCV RNA (64.3%) and anti-HEV IgM testing (70%), leading to loss of up to 6 points in RECAM scoring but not impacting RUCAM scores. A modified RECAM that made HCV RNA and anti-HEV IgM optional had better agreement with DILIN expert opinion compared to RUCAM (79.2% vs. 66.7%, p=0.09). CONCLUSION Among 120 suspected DILI cases, RUCAM had better agreement with DILIN expert opinion scores versus RECAM. Making HCV RNA and anti-HEV IgM testing optional significantly improved agreement between RECAM and DILIN expert opinion. Future modifications to RECAM are needed to improve causality assessment in North American patients with suspected DILI.

中文翻译：

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提高 RECAM 在北美疑似特异质性药物性肝损伤患者中的诊断准确性：提高 RECAM 的准确性。


背景 RECAM 是 RUCAM 的更新电子版本，用于诊断 DILI。本研究的主要目的是比较 RECAM 与 RUCAM 在疑似 DILI 患者中的疗效。方法 使用 ICD-10 K71 中毒性肝病代码搜索 2015 年 10 月 1 日至 2019 年 9 月 30 日的患者就诊，寻找疑似 DILI。为每个病例分配 DILIN 专家意见评分 （1/2/3 = 可能的 DILI，4/5 = 非 DILI）。将 RECAM 和 RUCAM 评分与 DILIN 专家意见评分进行比较。结果 在搜索的 766,930 次就诊中，120 名独特的患者符合纳入标准，其中 72 名 （60%） 被判定为可能的 DILI。最常见的可疑药物是抗菌药物 （38.3%） 、抗肿瘤药物 （8.3%） 和抗风湿药 （8.3%）。平均年龄为 49.2 + 15.6 岁，50% 为女性，45.8% 为肝细胞损伤。RUCAM 与 RECAM 相比，与可能的 DILI 相比，与 DILIN 专家意见的一致性更高 （66.7% vs. 44.4%，p=0.018）。两者都 100% 同意 DILIN 专家对非 DILI 的意见。经常缺失的实验室数据包括 HCV RNA （64.3%） 和抗 HEV IgM 检测 （70%），导致 RECAM 评分损失高达 6 分，但不影响 RUCAM 评分。与 RUCAM 相比，使 HCV RNA 和抗 HEV IgM 可选的改良 RECAM 与 DILIN 专家意见的一致性更高 （79.2% vs. 66.7%，p=0.09）。结论 在 120 例疑似 DILI 病例中，RUCAM 与 DILIN 专家意见评分的一致性优于 RECAM。将 HCV RNA 和抗 HEV IgM 检测设为可选，显著提高了 RECAM 和 DILIN 专家意见之间的一致性。未来需要对 RECAM 进行修改，以改善疑似 DILI 的北美患者的因果关系评估。