Development and validation of lupus nephritis case definitions using United States veterans affairs electronic health records
| Autor: | Xinliang Huang, Yan Xie, Seth A. Eisen, Divya Jayakumar, Tingting Li, Prabha Ranganathan, Iris Lee |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Databases Factual Lupus nephritis Health records Sensitivity and Specificity Cohort Studies 03 medical and health sciences 0302 clinical medicine Rheumatology International Classification of Diseases medicine Electronic Health Records Humans 030212 general & internal medicine Veterans Affairs Veterans 030203 arthritis & rheumatology business.industry Middle Aged medicine.disease Lupus Nephritis United States United States Department of Veterans Affairs Family medicine Female business |
| Zdroj: | Lupus. 30:518-526 |
| ISSN: | 1477-0962 0961-2033 |
| DOI: | 10.1177/0961203320973267 |
| Popis: | Objective International Classification of Diseases (ICD) codes are commonly used to identify patients with rare diseases in electronic health records (EHRs). However, misclassification is common, impacting the validity of study results. In this study, we compared the accuracies of several ICD-based case definitions of lupus nephritis (LN) in identifying United States veterans with LN. Methods Using the Department of Veterans Affairs (VA) EHR, we identified all veterans with ≥1 ICD-9 or 10 diagnostic codes for systemic lupus erythematosus (SLE) between October 1, 1999 and September 30, 2017. A cohort was randomly selected for diagnostic validation and 9 ICD-based LN case definitions were applied to this cohort. The diagnostic accuracy of each definition was assessed against gold standard criterion of biopsy-proven LN. Results 18,420 veterans had ≥1 ICD-9 or 10 diagnostic codes for SLE; 981 were randomly selected for diagnostic validation. 95 veterans (9.7%) had biopsy-proven LN. The case definitions had high specificity and NPV but variable sensitivity and PPV. The definition containing ≥2 ICD -9 codes for SLE and ≥2 nephritis indicators had the highest combination of sensitivity and specificity (87.4% and 94.6% respectively). ICD-10 code for LN had high specificity (99.8%) and PPV (93.9%). Conclusion ICD-based case definitions of LN in the VA population have high specificity and NPV but variable sensitivity and PPV. Our results may help guide the design of future LN studies in VA cohorts. The choice of specific case definitions depends on the relative importance of different accuracy measures to individual studies. |
| Databáze: | OpenAIRE |
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