Kaiser Permanente Colorado Institute for Health Research, Denver, CO 80237-8066, USA.
Pharmacoepidemiol Drug Saf. 2010 Nov;19(11):1204-8. doi: 10.1002/pds.2030.
Our objectives were to determine performance of coded hyperkalemia diagnosis at identifying (1) clinically evident hyperkalemia and (2) serum potassium>6 mmol/L.
This retrospective observational study included 8722 patients with diabetes within an integrated healthcare system who newly initiated an angiotensin converting enzyme inhibitor, angiotensin receptor blocker, or spironolactone. The primary outcome was first hyperkalemia-associated event (hospitalization, emergency department visit or death within 24 hours of coded diagnosis and/or potassium≥6 mmol/L) during the first year of therapy. Medical records were reviewed.
Among a random sample of 99 patients not coded as having hyperkalemia, none had hyperkalemia upon record review. Among all 64 patients identified as having hyperkalemia, all had hospitalization or emergency department visit associated with coded diagnosis or elevated potassium. Of 55 with coded diagnosis, 42 (PPV 76%) had clinically evident hyperkalemia; 32 (PPV 58%) had potassium≥6. Of 9 identified using only potassium≥6, 7 (PPV 78%) had clinically evident hyperkalemia.
Nearly one-fourth of patients with coded diagnosis do not have clinically evident hyperkalemia and nearly one-half do not have potassium≥6. Because both false positives and negatives occur with coded diagnoses, medical record validation of hyperkalemia-associated outcomes is necessary.
我们的目的是确定编码高钾血症诊断在识别（1）临床明显高钾血症和（2）血清钾>6mmol/L 方面的性能。
这项回顾性观察性研究纳入了在一个综合医疗保健系统中患有糖尿病的 8722 名新开始使用血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂或螺内酯的患者。主要结局是在治疗的第一年中首次发生高钾血症相关事件（编码诊断后 24 小时内住院、急诊就诊或死亡，和/或血钾≥6mmol/L）。审查了医疗记录。
在未编码为高钾血症的 99 名患者的随机样本中，没有记录显示有高钾血症。在所有 64 名被确定为高钾血症的患者中，所有患者均因编码诊断或血钾升高而住院或急诊就诊。在有编码诊断的 55 名患者中，42 名（PPV76%）有临床明显高钾血症；32 名（PPV58%）有血钾≥6mmol/L。在仅使用血钾≥6mmol/L 识别的 9 名患者中，7 名（PPV78%）有临床明显高钾血症。
近四分之一编码诊断的患者没有临床明显高钾血症，近一半没有血钾≥6mmol/L。由于编码诊断既存在假阳性也存在假阴性，因此有必要对高钾血症相关结局进行医疗记录验证。
