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 肝硬化是美国死亡率的主要原因（美国），被诊断为数百万人，导致 每年超过40,000人死亡，主要是老年人。这些患者的严重风险更高 并发症（例如感染，腹水，肝脑病），住院和死亡。对 流行病学和疾病进展和老年患者更脆弱，风险可能不同 概况。临床挑战是​​准确和早期预测谁面临最高风险 住院和/或死亡以及了解年龄较大的年轻人可能有何不同。 。 迄今为止的一个障碍是缺乏捕获这些样本的流行病学代表性的患者样本 肝硬化并超越了一个卫生系统，因为许多数据存储库都是偏斜或有限的：仅CMS NIS捕获老年人和有骨质的人，不允许纵向观察，UNOS代表较少 肝硬化的人中有百分之一。因此，我们将以我们以前的工作为基础，以使用唯一的数据集， 芝加哥地区以患者为中心的结果研究网络（摩ri座）。摩ri座捕获 来自2011年至今的九个卫生系统的电子健康记录（EHR）（包括学术中心，县， 弗吉尼亚州和私人），在大芝加哥大都市地区捕捉大多数多样化的患者人口， 即约160,000名肝硬化患者。数据集很广泛，允许使用传统（例如， 回归）和新颖的分析技术（例如深度学习）来追求研究的目的。我们的目标 模型在老年人中的肝硬化进展，并预测老年患者住院和死亡的风险 与肝硬化。我们还旨在进行侧重于种族和社会经济因素的亚组分析 老年。准确和早期预测死亡率和住院风险对老年患者的影响 肝硬化允许对最脆弱的患者进行有针对性的干预措施，以改善预后。