LIVOPT -- LIVer cirrhosis - Optimizing Prediction of Patient OuTcomes

LIVOPT——肝硬化——优化患者结果的预测

• 批准号: 10490243
• 负责人: Daniela P Ladner
• 金额: $ 63.51万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10490243
• 关键词: Affect; Area; Ascites; Attention; Black race; Caring; Cause of Death; Cessation of life; Chicago; Cirrhosis; Clinical; County; Data; Data Set; Development; Diagnosis; Disease Progression; Disease model; Elderly; Electronic Health Record; Epidemiology; Event; Gastrointestinal Hemorrhage; Graph; Health system; Hepatic Encephalopathy; Hospitalization; Infection; Inpatients; Insurance; Intensive Care; Intervention; Knowledge; Life Experience; Liver; Liver Cirrhosis; Machine Learning; Medical; Modeling; Outcomes Research; Patient Representative; Patient-Focused Outcomes; Patients; Pattern; Persons; Population; Primary carcinoma of the liver cells; Privatization; Probability; Public Health; Race; Research; Resources; Risk; Risk Estimate; Sampling; Sampling Biases; Socioeconomic Factors; Subgroup; Techniques; Time; Transplantation; United Network for Organ Sharing; United States; United States Centers for Medicare and Medicaid Services; United States Department of Veterans Affairs; Work; adjudicate; black patient; cost; data repository; deep learning; disability; disorder risk; end stage liver disease; high risk; improved outcome; metropolitan; mortality; mortality risk; novel; older patient; organ allocation; patient population; patient subsets; population based; predictive modeling; risk prediction; transplant model; young adult

PROJECT ABSTRACT Cirrhosis is a leading cause of mortality in the United States (US), diagnosed in millions of people and resulting in over 40,000 deaths each year, predominately in older people. These patients are at higher risk of serious complications (e.g. infection, ascites, hepatic encephalopathy), hospitalization and death. Little is known about the epidemiology and disease progression and older patients are more vulnerable and might have different risk profiles. The clinical challenge is to accurately and early predict who is at highest risk for requiring hospitalization and/or death and understanding how this might be different in older versus younger adults. . One barrier to date has been the lack of an epidemiologically representative patient sample that captures those with cirrhosis and goes beyond one health system, as many data repositories are skewed or limited: CMS only captures elderly and those with debility, NIS does not allow longitudinal observation, UNOS represents less than one percent of those with cirrhosis. Hence, we will build on our previous work to use a unique dataset, the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN). CAPriCORN captures the electronic health records (EHR) from nine health systems from 2011-present (incl. academic center, county, VA and private), catching most of the diverse patient population in the greater Chicago metropolitan area, namely ~160,000 patients with liver cirrhosis. The dataset is extensive, allowing the use of traditional (e.g., regression) and novel analytical techniques (e.g. deep learning) to pursue the aims of the study. We aim to model cirrhosis progression in the elderly and to predict the risk of hospitalization and death in older patients with cirrhosis. We also aim to perform sub-group analyses focusing on race and socioeconomic factors in the elderly. The impact of accurate and early prediction of mortality and hospitalization risk in elderly patients with cirrhosis allows for targeted interventions of the most vulnerable patients to improve outcomes.

项目摘要 肝硬化是美国 (US) 死亡的主要原因，数百万人被诊断出肝硬化，并由此导致肝硬化 每年有超过 40,000 人死亡，其中大多数是老年人。这些患者患严重疾病的风险较高 并发症（例如感染、腹水、肝性脑病）、住院和死亡。鲜为人知的是 流行病学和疾病进展以及老年患者更容易受到伤害，并且可能有不同的风险 配置文件。临床挑战是​​准确、早期地预测谁面临最高的风险 住院和/或死亡，并了解老年人与年轻人的情况有何不同。 。 迄今为止的一个障碍是缺乏具有流行病学代表性的患者样本来捕获这些样本 患有肝硬化并且超出了一个卫生系统，因为许多数据存储库存在偏差或有限：仅限 CMS 捕捉老年人和体弱者，NIS 不允许纵向观察，UNOS 代表较少 不到百分之一的肝硬化患者。因此，我们将在之前的工作基础上使用一个独特的数据集，即 芝加哥地区以患者为中心的结果研究网络 (CAPriCORN)。 CAPriCORN 捕捉到 2011 年至今九个卫生系统的电子健康记录 (EHR)（包括学术中心、县、 VA 和私立医院），吸引了大芝加哥都市区的大多数多样化患者群体， 即约 160,000 名肝硬化患者。该数据集非常广泛，允许使用传统的（例如， 回归）和新颖的分析技术（例如深度学习）来实现研究目标。我们的目标是 建立老年人肝硬化进展模型并预测老年患者住院和死亡的风险 患有肝硬化。我们还旨在进行亚组分析，重点关注种族和社会经济因素 老年。准确、早期预测老年患者死亡率和住院风险的影响 肝硬化可以对最脆弱的患者进行有针对性的干预，以改善结果。