TY - JOUR
T1 - Awareness of drug laboratory test interactions is important for prevention of unnecessary additional diagnostics
T2 - An example
AU - van Balveren, Jasmijn A.
AU - Erdem-Eraslan, Lale
AU - Verboeket-van de Venne, Wilhelmine P.H.G.
AU - Doggen, Carine J.M.
AU - Hofland, Johannes
AU - Oosterhuis, Wytze P.
AU - de Rijke, Yolanda B.
AU - Hoedemakers, Rein M.J.
AU - Kusters, Ron
N1 - Funding Information:
Not applicable. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Background: Elevated levels of Chromogranin A (CgA) may be indicative of a neuroendocrine tumour (NET), but increased levels are also observed after intake of proton pump inhibitors (PPIs). The incidence of diagnostic confusion because of this drug-laboratory test interaction (DLTI) was examined. Methods: Medical records of 238 patients with elevated CgA concentrations were obtained from three hospitals. The following data were extracted: PPI prescription at the time of CgA measurement, medical decision making based on elevated CgA concentrations, final diagnosis, comorbidity and other prescribed drugs. Results: From 238 patients with elevated CgA concentrations, 132 used PPIs. Of these patients, 57 patients did not have a NET. In 9 of these 57 patients (16%), diagnostic work up revealed no medical cause of an elevated CgA concentration. Somatostatin receptor imaging was ordered in 4 out of 9 cases, with no abnormalities observed. In 6 out of 9 cases, CgA measurement was repeated after PPI discontinuation resulting in normalisation of CgA concentrations. Conclusion: In this retrospective patient record study we observed that part of the elevated CgA concentrations in patients could be caused by the usage of PPIs causing unnecessary diagnostic work-up for the exclusion of a NET. These observations illustrate the need for better DLTI awareness.
AB - Background: Elevated levels of Chromogranin A (CgA) may be indicative of a neuroendocrine tumour (NET), but increased levels are also observed after intake of proton pump inhibitors (PPIs). The incidence of diagnostic confusion because of this drug-laboratory test interaction (DLTI) was examined. Methods: Medical records of 238 patients with elevated CgA concentrations were obtained from three hospitals. The following data were extracted: PPI prescription at the time of CgA measurement, medical decision making based on elevated CgA concentrations, final diagnosis, comorbidity and other prescribed drugs. Results: From 238 patients with elevated CgA concentrations, 132 used PPIs. Of these patients, 57 patients did not have a NET. In 9 of these 57 patients (16%), diagnostic work up revealed no medical cause of an elevated CgA concentration. Somatostatin receptor imaging was ordered in 4 out of 9 cases, with no abnormalities observed. In 6 out of 9 cases, CgA measurement was repeated after PPI discontinuation resulting in normalisation of CgA concentrations. Conclusion: In this retrospective patient record study we observed that part of the elevated CgA concentrations in patients could be caused by the usage of PPIs causing unnecessary diagnostic work-up for the exclusion of a NET. These observations illustrate the need for better DLTI awareness.
KW - Clinical laboratory test
KW - Diagnostic error
KW - Drug laboratory test interaction
KW - Patient safety
KW - 2023 OA procedure
UR - http://www.scopus.com/inward/record.url?scp=85126691667&partnerID=8YFLogxK
U2 - 10.1016/j.cca.2022.03.013
DO - 10.1016/j.cca.2022.03.013
M3 - Article
C2 - 35306022
AN - SCOPUS:85126691667
SN - 0009-8981
VL - 530
SP - 99
EP - 103
JO - Clinica Chimica Acta
JF - Clinica Chimica Acta
ER -
