Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, 1265 Welch Road, MSOB, X-215, Stanford, CA 94305-5479, USA.
Pediatr Rheumatol Online J. 2013 Dec 3;11(1):45. doi: 10.1186/1546-0096-11-45.
Juvenile idiopathic arthritis is the most common rheumatic disease in children. Chronic uveitis is a common and serious comorbid condition of juvenile idiopathic arthritis, with insidious presentation and potential to cause blindness. Knowledge of clinical associations will improve risk stratification. Based on clinical observation, we hypothesized that allergic conditions are associated with chronic uveitis in juvenile idiopathic arthritis patients.
This study is a retrospective cohort study using Stanford's clinical data warehouse containing data from Lucile Packard Children's Hospital from 2000-2011 to analyze patient characteristics associated with chronic uveitis in a large juvenile idiopathic arthritis cohort. Clinical notes in patients under 16 years of age were processed via a validated text analytics pipeline. Bivariate-associated variables were used in a multivariate logistic regression adjusted for age, gender, and race. Previously reported associations were evaluated to validate our methods. The main outcome measure was presence of terms indicating allergy or allergy medications use overrepresented in juvenile idiopathic arthritis patients with chronic uveitis. Residual text features were then used in unsupervised hierarchical clustering to compare clinical text similarity between patients with and without uveitis.
Previously reported associations with uveitis in juvenile idiopathic arthritis patients (earlier age at arthritis diagnosis, oligoarticular-onset disease, antinuclear antibody status, history of psoriasis) were reproduced in our study. Use of allergy medications and terms describing allergic conditions were independently associated with chronic uveitis. The association with allergy drugs when adjusted for known associations remained significant (OR 2.54, 95% CI 1.22-5.4).
This study shows the potential of using a validated text analytics pipeline on clinical data warehouses to examine practice-based evidence for evaluating hypotheses formed during patient care. Our study reproduces four known associations with uveitis development in juvenile idiopathic arthritis patients, and reports a new association between allergic conditions and chronic uveitis in juvenile idiopathic arthritis patients.
幼年特发性关节炎是儿童中最常见的风湿性疾病。慢性葡萄膜炎是幼年特发性关节炎的一种常见且严重的合并症，其表现隐匿，有导致失明的潜在风险。对临床相关性的了解将有助于进行风险分层。基于临床观察，我们假设过敏状态与幼年特发性关节炎患者的慢性葡萄膜炎有关。
本研究为回顾性队列研究，利用斯坦福大学临床数据仓库（包含了 2000 年至 2011 年卢塞利·帕克德儿童医院的数据），对大量幼年特发性关节炎队列中的慢性葡萄膜炎患者的特征进行分析。通过经过验证的文本分析管道对 16 岁以下患者的临床记录进行处理。使用多元逻辑回归对年龄、性别和种族进行调整，分析与慢性葡萄膜炎相关的双变量关联变量。评估了先前报道的相关性，以验证我们的方法。主要观察指标为在患有慢性葡萄膜炎的幼年特发性关节炎患者中，存在表示过敏或使用过敏药物的术语的情况。然后使用无监督层次聚类比较有和无葡萄膜炎患者的临床文本相似性。
本研究重现了与幼年特发性关节炎患者葡萄膜炎相关的先前报道的相关性（关节炎诊断年龄较早、少关节型发病、抗核抗体状态、银屑病病史）。使用过敏药物和描述过敏状态的术语与慢性葡萄膜炎独立相关。在调整已知相关性后，与过敏药物的关联仍然显著（OR 2.54，95%CI 1.22-5.4）。
本研究表明，在临床数据仓库中使用经过验证的文本分析管道来检查基于实践的证据以评估患者护理过程中形成的假设具有潜力。本研究重现了与幼年特发性关节炎患者葡萄膜炎发展相关的四个已知相关性，并报告了幼年特发性关节炎患者中过敏状态与慢性葡萄膜炎之间的新相关性。
