CIOMS/RUCAM scale

The CIOMS/RUCAM scale is a tool to predict whether liver damage can be attributed to a particular medication.

Hepatotoxicity

Determining hepatotoxicity (toxic effects of a substance on the liver) remains a major challenge in clinical practice due to lack of reliable markers.cite journal |author=Andrade RJ, Robles M, Fernández-Castañer A, López-Ortega S, López-Vega MC, Lucena MI |title=Assessment of drug-induced hepatotoxicity in clinical practice: a challenge for gastroenterologists |journal=World J. Gastroenterol. |volume=13 |issue=3 |pages=329–40 |year=2007 |pmid=17230599 |url=http://www.wjgnet.com/1007-9327/13/329.asp|doi=] Many other conditions lead to similar clinical as well as pathological picture. To diagnose hepatotoxicity, a causal relationship between the use of the toxin or drug and subsequent liver damage has to be established, but might be difficult, especially when idiosyncratic reaction is suspected. [cite journal |author=Arundel C, Lewis JH |title=Drug-induced liver disease in 2006 |journal=Curr. Opin. Gastroenterol. |volume=23 |issue=3 |pages=244–54 |year=2007 |pmid=17414839 |doi=10.1097/MOG.0b013e3280b17dfb] Simultaneous use of multiple drugs may add to the complexity. As in acetaminophen toxicity, well established dose dependent pharmacological hepatotoxicity is easier to spot.

Interpretation

The CIOMS/RUCAM scale has been proposed to establish causal relationship between offending drug and liver damage. The CIOMS/RUCAM scale involves a scoring system which categorizes the suspicion into "definite or highly probable" (score > 8), "probable" (score 6-8), "possible" (score 3-5), "unlikely" (score 1-2) and "excluded" (score ≤ 0). In clinical practice physicians put more emphasis on the presence or absence of similarity between the biochemical profile of the patient and known biochemical profile of the suspected toxicity ( e.g. cholestatic damage in amoxycillin-clauvonic acid ).

Elements of the scale

* "Concomitant therapy:"
**Time to onset incompatible: +0
**Time to onset compatible but with unknown reaction: -1
**Time to onset compatible but known reaction: -2
**Role proved in this case: -3
**None or information not available: +0

* "Exclusion of nondrug-related causes:"
**Rule out: +2
**“Possible” to “not investigated”: -2 to +1
**Probable: -3

* "Previous information on hepatotoxicity:"
**Reaction unknown: +0
**Reaction published but unlabeled: +1
**Reaction labeled in the product's characteristics: +2

* "Response to re-administration:"
**Positive: +3
**Compatible: +1
**Negative: -2
**Not available or not interpretable: +0
**or plasma concentration of drug known as toxic: +3
**or validated laboratory test with high specificity, sensitivity, and predictive values:
***Positive: +3
***Negative: -3
***Not interpretable or not available: +0

core analysis

Points are summed and the total compared to this chart:

* 0 or lower: relationship with the drug excluded
* 1-2: unlikely
* 3-5: possible
* 6-8: probable
* >8: highly probable

If the results are incompatible with a connection, then the case is considered "unrelated".In some cases, insufficient information is available; these cases are recorded as "insufficiently documented".

ee also

* Hepatotoxicity

References