Near-Term Prediction of Sudden Cardiac Death in Older Hemodialysis Patients Using Electronic Health Records
Near-Term Prediction of Sudden Cardiac Death in Older Hemodialysis Patients Using Electronic Health Records
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DOI：
10.2215/cjn.03050313
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发表时间：
2014-01-07
影响因子：
9.8
通讯作者：
Winkelmayer, Wolfgang C.
中科院分区：
文献类型：
--
作者：
Goldstein, Benjamin A.;Chang, Tara I.;Winkelmayer, Wolfgang C.
背景和目的心脏性猝死是血液透析患者最常见的死亡原因。心源性猝死的流行病学已得到充分研究，工作正在转向风险评估。本研究的目的是测试是否在血液透析过程中，在电子健康记录中捕获的急性变化的评估，提高了风险assessment.Design，设置，参与者，和measurementsData收集从所有血液透析会议的患者66岁及以上接受血液透析从一个大型的国家透析供应商在2004年和2008年之间。关注的主要结局是透析当天或透析后一天的心源性猝死。该研究使用2004年至2006年的数据作为训练集，2007年至2008年的数据作为验证集。机器学习算法，随机森林，被用来推导出的预测model.ResultsIn 22万会话，898人之间的2004年和2006年和826人之间的2007年和2008年死亡的一天或一天后，透析会议是作为一个训练或测试数据会话，分别。仅使用透析前信息得出一个相当强的预测因子（一致性统计=0.782），在包括透析后信息后显示出适度但显著的改善（一致性统计=0.799，P
Background and objectivesSudden cardiac death is the most common cause of death among individuals undergoing hemodialysis. The epidemiology of sudden cardiac death has been well studied, and efforts are shifting to risk assessment. This study aimed to test whether assessment of acute changes during hemodialysis that are captured in electronic health records improved risk assessment.Design, setting, participants, & measurementsData were collected from all hemodialysis sessions of patients 66 years and older receiving hemodialysis from a large national dialysis provider between 2004 and 2008. The primary outcome of interest was sudden cardiac death the day of or day after a dialysis session. This study used data from 2004 to 2006 as the training set and data from 2007 to 2008 as the validation set. The machine learning algorithm, Random Forests, was used to derive the prediction model.ResultsIn 22 million sessions, 898 people between 2004 and 2006 and 826 people between 2007 and 2008 died on the day of or day after a dialysis session that was serving as a training or test data session, respectively. A reasonably strong predictor was derived using just predialysis information (concordance statistic=0.782), which showed modest but significant improvement after inclusion of postdialysis information (concordance statistic=0.799, P