University of New Mexico School of Medicine, USA.
Health Informatics J. 2018 Dec;24(4):394-409. doi: 10.1177/1460458216675661. Epub 2016 Nov 17.
Chronic obstructive pulmonary disease is a heterogeneous disease. In this retrospective study, we hypothesize that it is possible to identify clinically relevant phenotypes by applying clustering methods to electronic medical records. We included all the patients >40 years with a diagnosis of chronic obstructive pulmonary disease admitted to the University of New Mexico Hospital between 1 January 2011 and 1 May 2014. We collected admissions, demographics, comorbidities, severity markers and treatments. A total of 3144 patients met the inclusion criteria: 46 percent were >65 years and 52 percent were males. The median Charlson score was 2 (interquartile range: 1-4) and the most frequent comorbidities were depression (36%), congestive heart failure (25%), obesity (19%), cancer (19%) and mild liver disease (18%). Using the sphere exclusion method, nine clusters were obtained: depression-chronic obstructive pulmonary disease, coronary artery disease-chronic obstructive pulmonary disease, cerebrovascular disease-chronic obstructive pulmonary disease, malignancy-chronic obstructive pulmonary disease, advanced malignancy-chronic obstructive pulmonary disease, diabetes mellitus-chronic kidney disease-chronic obstructive pulmonary disease, young age-few comorbidities-high readmission rates-chronic obstructive pulmonary disease, atopy-chronic obstructive pulmonary disease, and advanced disease-chronic obstructive pulmonary disease. These clusters will need to be validated prospectively.
慢性阻塞性肺疾病是一种异质性疾病。在这项回顾性研究中，我们假设通过应用聚类方法对电子病历进行分析，可以识别出具有临床意义的表型。我们纳入了 2011 年 1 月 1 日至 2014 年 5 月 1 日期间在新墨西哥大学医院就诊的所有年龄大于 40 岁的慢性阻塞性肺疾病诊断患者。我们收集了入院信息、人口统计学特征、合并症、严重程度标志物和治疗情况。共有 3144 名患者符合纳入标准：46%的患者年龄大于 65 岁，52%的患者为男性。Charlson 评分中位数为 2（四分位距：1-4），最常见的合并症是抑郁症（36%）、充血性心力衰竭（25%）、肥胖症（19%）、癌症（19%）和轻度肝疾病（18%）。使用球排除法，得到了 9 个聚类：抑郁症-慢性阻塞性肺疾病、冠心病-慢性阻塞性肺疾病、脑血管疾病-慢性阻塞性肺疾病、恶性肿瘤-慢性阻塞性肺疾病、晚期恶性肿瘤-慢性阻塞性肺疾病、糖尿病-慢性肾脏病-慢性阻塞性肺疾病、年轻患者-合并症少-高再入院率-慢性阻塞性肺疾病、特应性-慢性阻塞性肺疾病和晚期疾病-慢性阻塞性肺疾病。这些聚类需要前瞻性验证。
