Novel computational methods on electronic health record yields new estimates of transfusion-associated circulatory overload in populations enriched with high-risk patients.
Novel computational methods on electronic health record yields new estimates of transfusion-associated circulatory overload in populations enriched with high-risk patients.
复制标题
电子健康记录的新颖计算方法可以对富含高危患者的人群中与输血相关的循环超负荷进行新的估计。
DOI：
10.1111/trf.17447
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发表时间：
2023
期刊：
影响因子：
2.9
通讯作者：
Butte,AtulJ
中科院分区：
文献类型：
--
作者：
Wang,Michelle;Goldgof,GregoryM;Patel,Ayan;Whitaker,Barbee;Belov,Artur;Chan,Brian;Phelps,Evan;Rubin,Benjamin;Anderson,Steven;Butte,AtulJ
输血相关循环超负荷（TACO）是一种严重的不良反应（AR），是输血相关死亡的主要原因。作为战略，以减轻TACO已越来越多地通过，更新的患病率和风险因素与TACO使用越来越多的电子健康记录（EHR）数据的来源可以帮助了解transfusionsafety.Study Design and MethodsThis回顾性研究旨在提供一个及时和可重复的评估患病率和风险因素与TACO。新的自然语言处理方法现已在GitHub上公开发布，用于从3178份输血反应报告中提取AR。其他患者层面的数据是从2012年至2022年期间的UCSF EHR中通过计算提取的。使用多变量logistic回归分析计算风险因素的比值比估计值，病例与对照在性别和年龄上以1：5的比例匹配。结果在研究期间，共有56，208例患者在UCSF接受输血（总计573，533单位），102例患者发生TACO。TACO的患病率估计为每例患者0.2%（102/总计56，208）。有凝血功能障碍（OR，1.36; 95%CI，1.04-1.79）和移植（OR，1.99; 95%CI，1.48-2.68）病史的患者与TACO.DiscussionWhile TACO是一种严重AR，即使在高风险患者人群中，事件仍然罕见。新的计算方法可用于发现和持续监测输血AR。结果表明，应仔细监测有凝血病和器官移植病史或存在凝血病和器官移植的患者，以减轻TACO的潜在风险。
BackgroundTransfusion‐associated circulatory overload (TACO) is a severe adverse reaction (AR) contributing to the leading cause of mortality associated with transfusions. As strategies to mitigate TACO have been increasingly adopted, an update of prevalence rates and risk factors associated with TACO using the growing sources of electronic health record (EHR) data can help understand transfusion safety.Study Design and MethodsThis retrospective study aimed to provide a timely and reproducible assessment of prevalence rates and risk factors associated with TACO. Novel natural language processing methods, now made publicly available on GitHub, were developed to extract ARs from 3178 transfusion reaction reports. Other patient‐level data were extracted computationally from UCSF EHR between 2012 and 2022. The odds ratio estimates of risk factors were calculated using a multivariate logistic regression analysis with case‐to‐control matched on sex and age at a ratio of 1:5.ResultsA total of 56,208 patients received transfusions (total 573,533 units) at UCSF during the study period and 102 patients developed TACO. The prevalence of TACO was estimated to be 0.2% per patient (102/total 56,208). Patients with a history of coagulopathy (OR, 1.36; 95% CI, 1.04–1.79) and transplant (OR, 1.99; 95% CI, 1.48–2.68) were associated with increased odds of TACO.DiscussionWhile TACO is a serious AR, events remained rare, even in populations enriched with high‐risk patients. Novel computational methods can be used to find and continually surveil for transfusion ARs. Results suggest that patients with history or presence of coagulopathy and organ transplant should be carefully monitored to mitigate potential risks of TACO.