Awareness of drug laboratory test interactions is important for prevention of unnecessary additional diagnostics: An example

Jasmijn A van Balveren; Lale Erdem-Eraslan; Wilhelmine P H G Verboeket-van de Venne; Carine J M Doggen; Johannes Hofland; Wytze P Oosterhuis; Yolanda B de Rijke; Rein M J Hoedemakers; Ron Kusters

doi:10.1016/j.cca.2022.03.013

Awareness of drug laboratory test interactions is important for prevention of unnecessary additional diagnostics: An example

Clin Chim Acta. 2022 May 1:530:99-103. doi: 10.1016/j.cca.2022.03.013. Epub 2022 Mar 16.

Authors

Jasmijn A van Balveren¹, Lale Erdem-Eraslan², Wilhelmine P H G Verboeket-van de Venne³, Carine J M Doggen⁴, Johannes Hofland⁵, Wytze P Oosterhuis³, Yolanda B de Rijke², Rein M J Hoedemakers⁶, Ron Kusters⁷

Affiliations

¹ Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ 's-Hertogenbosch, The Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH Enschede, The Netherlands. Electronic address: ja.van.balveren@stjansdal.nl.
² Department of Clinical Chemistry, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
³ Department of Clinical Chemistry, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.
⁴ Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH Enschede, The Netherlands.
⁵ ENETS Center of Excellence, Department of Internal Medicine, Section of Endocrinology, Erasmus University Medical Centre and Erasmus Cancer Institute, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
⁶ Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ 's-Hertogenbosch, The Netherlands.
⁷ Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ 's-Hertogenbosch, The Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH Enschede, The Netherlands.

PMID: 35306022
DOI: 10.1016/j.cca.2022.03.013

Abstract

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.

Keywords: Clinical laboratory test; Diagnostic error; Drug laboratory test interaction; Patient safety.

MeSH terms

Biomarkers, Tumor
Chromogranin A
Humans
Neuroendocrine Tumors* / diagnosis
Proton Pump Inhibitors / therapeutic use
Retrospective Studies

Substances

Biomarkers, Tumor
Chromogranin A
Proton Pump Inhibitors