Department of Medicine, University of Washington, Seattle, WA, USA.
Mid-Atlantic Permanente Research Institute Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.
Pharmacoepidemiol Drug Saf. 2019 Feb;28(2):140-147. doi: 10.1002/pds.4567. Epub 2018 Jun 20.
No prior studies have addressed the performance of electronic health record (EHR) data to diagnose chronic obstructive pulmonary disease (COPD) in people living with HIV (PLWH), in whom COPD could be more likely to be underdiagnosed or misdiagnosed, given the higher frequency of respiratory symptoms and smoking compared with HIV-uninfected (uninfected) persons.
We determined whether EHR data could improve accuracy of ICD-9 codes to define COPD when compared with spirometry in PLWH vs uninfected, and quantified level of discrimination using the area under the receiver-operating curve (AUC). The development cohort consisted of 350 participants who completed research spirometry in the Examinations of HIV Associated Lung Emphysema (EXHALE) study, a pulmonary substudy of the Veterans Aging Cohort Study. Results were externally validated in 294 PLWH who performed spirometry for clinical indications from the University of Washington (UW) site of the Centers for AIDS Research Network of Integrated Clinical Systems cohort.
ICD-9 codes performed similarly by HIV status, but alone were poor at discriminating cases from non-cases of COPD when compared with spirometry (AUC 0.633 in EXHALE; 0.651 in the UW cohort). However, algorithms that combined ICD-9 codes with other clinical variables available in the EHR-age, smoking, and COPD inhalers-improved discrimination and performed similarly in EXHALE (AUC 0.771) and UW (AUC 0.734).
These data support that EHR data in combination with ICD-9 codes have moderately good accuracy to identify COPD when spirometry data are not available, and perform similarly in PLWH and uninfected individuals.
既往研究尚未探讨电子健康记录（EHR）数据在人免疫缺陷病毒（HIV）感染者（PLWH）中诊断慢性阻塞性肺疾病（COPD）的性能，由于与 HIV 未感染者（未感染者）相比，PLWH 更可能出现呼吸症状和吸烟频率更高，因此 COPD 更有可能被漏诊或误诊。
我们确定了在 PLWH 与未感染者中，与肺量计相比，EHR 数据是否可以通过 ICD-9 代码来改善 COPD 的准确性，并使用接受者操作特征曲线（ROC）下的面积（AUC）来量化鉴别水平。发展队列由 350 名完成了 HIV 相关肺大泡研究（EXHALE）研究中的研究性肺量计检查的参与者组成，该研究是退伍军人老龄化队列研究中肺子研究的一部分。结果在 294 名因临床指征而在华盛顿大学（UW）艾滋病研究网络综合临床系统队列的中心进行肺量计检查的 PLWH 中进行了外部验证。
按 HIV 状态，ICD-9 代码的表现相似，但与肺量计相比，单独使用时，区分 COPD 病例与非病例的能力较差（EXHALE 中的 AUC 为 0.633；UW 队列中的 AUC 为 0.651）。但是，将 ICD-9 代码与 EHR 中可用的其他临床变量（年龄、吸烟和 COPD 吸入器）相结合的算法改善了鉴别能力，并且在 EXHALE（AUC 为 0.771）和 UW（AUC 为 0.734）中表现相似。
这些数据支持 EHR 数据与 ICD-9 代码结合使用在没有肺量计数据时具有中度识别 COPD 的准确性，并且在 PLWH 和未感染者中表现相似。
