Diero Lameck, Stiffler Troy, Einterz Robert M, Tierney William M
Moi University Faculty of the Health Sciences, Eldoret, Kenya.
Int J Med Inform. 2004 Nov;73(11-12):743-50. doi: 10.1016/j.ijmedinf.2004.07.002.
Pneumocystis carinii is the leading opportunistic pulmonary infection in HIV-infected patients. Invasive diagnostic procedures might be avoided if available electronic data can accurately identify patients with Pneumocystis pneumonia (PCP).
We extracted data from electronic hospital records, emergency department records, and a pathology database for 299 HIV-infected patients with pneumonia who underwent bronchoscopy. We identified independent indicators of confirmed PCP using logistic regression analysis on a random half of the patients and validated the predictive power of the resulting model on the other half.
Bronchoscopy confirmed pneumocystis carinii in 111 patients (37%). Five of the seven significant independent predictors of PCP came from patients' electronic medical records: infiltrate on chest radiograph, male gender, lower red cell distribution width, lower serum creatinine, and a prior positive HIV test. The other two (duration of illness and presence of dyspnea) came from the emergency department record. A simple index found 43% of patients at low risk (18% with pneumocystis), 37% at moderate risk (36% with pneumocystis), and 20% at high risk (74% with pneumocystis).
Data from electronic medical records can help quantify the risk of PCP among HIV-infected patients. However, the model failed to identify 18% of patients with PCP in the low risk group, and empiric therapy would erroneously treat 26% of patients classified as high risk. Bronchoscopy is needed to accurately diagnose PCP among HIV-infected patients with pneumonia. However, if bronchoscopy is not available, the model can help with initial decisions about antibiotic therapy.
卡氏肺孢子菌是人类免疫缺陷病毒（HIV）感染患者最主要的机会性肺部感染病原体。如果现有电子数据能够准确识别卡氏肺孢子菌肺炎（PCP）患者，或许可以避免侵入性诊断程序。
我们从电子医院记录、急诊科记录以及一个病理数据库中提取了299例接受支气管镜检查的HIV感染肺炎患者的数据。我们对一半患者进行逻辑回归分析，确定PCP确诊的独立指标，并在另一半患者中验证所得模型的预测能力。
支气管镜检查确诊111例患者（37%）感染卡氏肺孢子菌。PCP的七个重要独立预测因素中有五个来自患者的电子病历：胸部X线片浸润影、男性、红细胞分布宽度较低、血清肌酐较低以及既往HIV检测呈阳性。另外两个因素（病程和呼吸困难的存在）来自急诊科记录。一个简单的指数显示，43%的患者为低风险（18%感染卡氏肺孢子菌），37%为中度风险（36%感染卡氏肺孢子菌），20%为高风险（74%感染卡氏肺孢子菌）。
电子病历数据有助于量化HIV感染患者发生PCP的风险。然而，该模型未能识别低风险组中18%的PCP患者，经验性治疗会错误地治疗26%被归类为高风险的患者。对于HIV感染的肺炎患者，需要进行支气管镜检查以准确诊断PCP。然而，如果无法进行支气管镜检查，该模型可帮助做出关于抗生素治疗的初步决策。
