Sarcopenia, frailty and cachexia patients detected in a multisystem electronic health record database
Abstract Background Sarcopenia, cachexia and frailty have overlapping features and clinical consequences, but often go unrecognized. The objective was to detect patients described by clinicians as having sarcopenia, cachexia or frailty within electronic health records (EHR) and compare clinical vari...
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doaj-637864326f11401eb736321a831d595e2020-11-25T02:37:16ZengBMCBMC Musculoskeletal Disorders1471-24742020-07-012111810.1186/s12891-020-03522-9Sarcopenia, frailty and cachexia patients detected in a multisystem electronic health record databaseRanjani N. Moorthi0Ziyue Liu1Sarah A. El-Azab2Lauren R. Lembcke3Matthew R. Miller4Andrea A. Broyles5Erik A. Imel6Department of Medicine, Indiana University School of MedicineDepartment of Biostatistics, Indiana University School of Public HealthCenter for Biomedical Informatics, Data Core Services, Regenstrief InstituteCenter for Biomedical Informatics, Data Core Services, Regenstrief InstituteCenter for Biomedical Informatics, Data Core Services, Regenstrief InstituteCenter for Biomedical Informatics, Data Core Services, Regenstrief InstituteDepartment of Medicine, Indiana University School of MedicineAbstract Background Sarcopenia, cachexia and frailty have overlapping features and clinical consequences, but often go unrecognized. The objective was to detect patients described by clinicians as having sarcopenia, cachexia or frailty within electronic health records (EHR) and compare clinical variables between cases and matched controls. Methods We conducted a case-control study using retrospective data from the Indiana Network for Patient Care multi-health system database from 2016 to 2017. The computable phenotype combined ICD codes for sarcopenia, cachexia and frailty, with clinical note text terms for sarcopenia, cachexia and frailty detected using natural language processing. Cases with these codes or text terms were matched to controls without these codes or text terms matched on birth year, sex and race. Two physicians reviewed EHR for all cases and a subset of controls. Comorbidity codes, laboratory values, and other coded clinical variables were compared between groups using Wilcoxon matched-pair sign-rank test for continuous variables and conditional logistic regression for binary variables. Results Cohorts of 9594 cases and 9594 matched controls were generated. Cases were 59% female, 69% white, and a median (1st, 3rd quartiles) age 74.9 (62.2, 84.8) years. Most cases were detected by text terms without ICD codes n = 8285 (86.4%). All cases detected by ICD codes (total n = 1309) also had supportive text terms. Overall 1496 (15.6%) had concurrent terms or codes for two or more of the three conditions (sarcopenia, cachexia or frailty). Of text term occurrence, 97% were used positively for sarcopenia, 90% for cachexia, and 95% for frailty. The remaining occurrences were negative uses of the terms or applied to someone other than the patient. Cases had lower body mass index, albumin and prealbumin, and significantly higher odds ratios for diabetes, hypertension, cardiovascular and peripheral vascular diseases, chronic kidney disease, liver disease, malignancy, osteoporosis and fractures (all p < 0.05). Cases were more likely to be prescribed appetite stimulants and caloric supplements. Conclusions Patients detected with a computable phenotype for sarcopenia, cachexia and frailty differed from controls in several important clinical variables. Potential uses include detection among clinical cohorts for targeting recruitment for research and interventions.http://link.springer.com/article/10.1186/s12891-020-03522-9 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ranjani N. Moorthi Ziyue Liu Sarah A. El-Azab Lauren R. Lembcke Matthew R. Miller Andrea A. Broyles Erik A. Imel |
spellingShingle |
Ranjani N. Moorthi Ziyue Liu Sarah A. El-Azab Lauren R. Lembcke Matthew R. Miller Andrea A. Broyles Erik A. Imel Sarcopenia, frailty and cachexia patients detected in a multisystem electronic health record database BMC Musculoskeletal Disorders |
author_facet |
Ranjani N. Moorthi Ziyue Liu Sarah A. El-Azab Lauren R. Lembcke Matthew R. Miller Andrea A. Broyles Erik A. Imel |
author_sort |
Ranjani N. Moorthi |
title |
Sarcopenia, frailty and cachexia patients detected in a multisystem electronic health record database |
title_short |
Sarcopenia, frailty and cachexia patients detected in a multisystem electronic health record database |
title_full |
Sarcopenia, frailty and cachexia patients detected in a multisystem electronic health record database |
title_fullStr |
Sarcopenia, frailty and cachexia patients detected in a multisystem electronic health record database |
title_full_unstemmed |
Sarcopenia, frailty and cachexia patients detected in a multisystem electronic health record database |
title_sort |
sarcopenia, frailty and cachexia patients detected in a multisystem electronic health record database |
publisher |
BMC |
series |
BMC Musculoskeletal Disorders |
issn |
1471-2474 |
publishDate |
2020-07-01 |
description |
Abstract Background Sarcopenia, cachexia and frailty have overlapping features and clinical consequences, but often go unrecognized. The objective was to detect patients described by clinicians as having sarcopenia, cachexia or frailty within electronic health records (EHR) and compare clinical variables between cases and matched controls. Methods We conducted a case-control study using retrospective data from the Indiana Network for Patient Care multi-health system database from 2016 to 2017. The computable phenotype combined ICD codes for sarcopenia, cachexia and frailty, with clinical note text terms for sarcopenia, cachexia and frailty detected using natural language processing. Cases with these codes or text terms were matched to controls without these codes or text terms matched on birth year, sex and race. Two physicians reviewed EHR for all cases and a subset of controls. Comorbidity codes, laboratory values, and other coded clinical variables were compared between groups using Wilcoxon matched-pair sign-rank test for continuous variables and conditional logistic regression for binary variables. Results Cohorts of 9594 cases and 9594 matched controls were generated. Cases were 59% female, 69% white, and a median (1st, 3rd quartiles) age 74.9 (62.2, 84.8) years. Most cases were detected by text terms without ICD codes n = 8285 (86.4%). All cases detected by ICD codes (total n = 1309) also had supportive text terms. Overall 1496 (15.6%) had concurrent terms or codes for two or more of the three conditions (sarcopenia, cachexia or frailty). Of text term occurrence, 97% were used positively for sarcopenia, 90% for cachexia, and 95% for frailty. The remaining occurrences were negative uses of the terms or applied to someone other than the patient. Cases had lower body mass index, albumin and prealbumin, and significantly higher odds ratios for diabetes, hypertension, cardiovascular and peripheral vascular diseases, chronic kidney disease, liver disease, malignancy, osteoporosis and fractures (all p < 0.05). Cases were more likely to be prescribed appetite stimulants and caloric supplements. Conclusions Patients detected with a computable phenotype for sarcopenia, cachexia and frailty differed from controls in several important clinical variables. Potential uses include detection among clinical cohorts for targeting recruitment for research and interventions. |
url |
http://link.springer.com/article/10.1186/s12891-020-03522-9 |
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