Abstract

Objective

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease that often follows pulmonary embolism (PE). Screening for CTEPH is challenging, often delaying diagnosis and worsening prognosis. Predictive risk models for CTEPH could help identify at-risk patients, but existing models require multiple clinical inputs. We developed and validated a predictive risk model for CTEPH using health insurance claims that can be used by payers/quality-of-care organizations to screen patients post-PE.

Methods

Adult patients newly diagnosed with acute PE (index date) were identified from the Optum De-identified Clinformatics Extended DataMart (January 2007–March 2018; development set) and IBM MarketScan (January 2008–June 2019; validation set) databases. Predictors were identified 12 months before or on the index PE. Risk of “likely CTEPH” was assessed post-PE based on CTEPH-related diagnoses and procedures since the CTEPH diagnosis code (ICD-10-CM: I27.24) was not available until 1 October 2017. Stepwise variable selection was used to build the model using the development set; model validation was subsequently conducted using the validation set.

Results

The development set included 93,428 patients, of whom 11,878 (12.7%) developed likely CTEPH. Older age (odds ratios [OR] = 1.16–1.49), female (OR = 1.09), unprovoked PE (i.e. without thrombotic factors; OR = 1.14), hypertension (OR = 1.07), osteoarthritis (OR = 1.08), diabetes (OR = 1.07), chronic obstructive pulmonary disease (OR = 1.11), obesity (OR = 1.21) were associated with higher odds of likely CTEPH, and oral anticoagulants with lower odds (OR= 0.50, all p < .01). C-statistic was 0.77 in the development and validation sets.

Conclusion

A claims-based risk model reliably predicted the risk of CTEPH post-PE and could be used to identify high-risk patients who may benefit from focused monitoring.

中文翻译：

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开发和验证基于索赔的模型，以识别急性肺栓塞后有慢性血栓栓塞性肺动脉高压风险的患者

摘要

客观的

慢性血栓栓塞性肺动脉高压 (CTEPH) 是一种罕见的疾病，常继发于肺栓塞 (PE)。CTEPH 的筛查具有挑战性，通常会延迟诊断和恶化预后。CTEPH 的预测风险模型可以帮助识别有风险的患者，但现有模型需要多个临床输入。我们使用健康保险索赔开发并验证了 CTEPH 的预测风险模型，付款人/护理质量组织可以使用该模型来筛查 PE 后的患者。

方法

从 Optum De-identified Clinformatics Extended DataMart（2007 年 1 月至 2018 年 3 月；开发集）和 IBM MarketScan（2008 年 1 月至 2019 年 6 月；验证集）数据库中识别出新诊断为急性 PE（索引日期）的成年患者。预测因子是在指数 PE 之前或之上 12 个月确定的。由于 CTEPH 诊断代码（ICD-10-CM：I27.24）直到 2017 年 10 月 1 日才可用，因此在 PE 后根据 CTEPH 相关诊断和程序评估了“可能 CTEPH”的风险。逐步变量选择用于构建使用开发集的模型；随后使用验证集进行模型验证。

结果

开发集包括 93,428 名患者，其中 11,878 (12.7%) 名患者可能发生 CTEPH。年龄较大（比值比 [OR] = 1.16–1.49）、女性（OR = 1.09）、无故 PE（即无血栓形成因素；OR = 1.14）、高血压（OR = 1.07）、骨关节炎（OR = 1.08）、糖尿病（ OR = 1.07)、慢性阻塞性肺疾病 (OR = 1.11)、肥胖 (OR = 1.21) 与更高的 CTEPH 几率相关，口服抗凝剂的几率较低（OR = 0.50，所有p  < .01）。在开发和验证集中，C 统计量为 0.77。

结论

基于索赔的风险模型可靠地预测了 PE 后 CTEPH 的风险，并可用于识别可能从重点监测中受益的高风险患者。