Histopathologic Features that Predict Transplant Glomerulopathy Progression in a Chinese Cohort

2019 ◽  
Vol 49 (6) ◽  
pp. 425-434 ◽  
Author(s):  
Xue Li ◽  
Jinsong Chen ◽  
Dongrui Cheng ◽  
Wei Wang ◽  
Kenan Xie ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Proportional Hazards ◽  
Linear Regression Analysis ◽  
Prognostic Significance ◽  
Immunoglobulin A ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Chinese Cohort ◽  
Transplant Glomerulopathy ◽  
Histopathologic Features

Background: Transplant glomerulopathy (TG) represents a major cause of long-term allograft failure and is the leading cause of overall post-transplant proteinuria. The extent to which histopathologic features predicts prognostication is uncertain. Methods: A single-center retrospective cohort with biopsy-proven TG was investigated. Renal biopsies were scored according to Banff 2017. The primary outcome was death-censored graft failure defined as return to dialysis or estimated glomerular filtration rate (eGFR) decreased to <15 mL/min/1.73 m2. The prognostic significance of clinical and histopathologic parameters was determined using Cox proportional hazards models. Results: Data from 180 cases were available for analysis with a median follow-up of 5.0 (2.6–8.2) years. In multivariable models, ci + ct score (HR 3.1; 95% CI 2.0–4.9), cg score (HR 1.7; 95% CI 1.1–2.8), eGFR (HR 2.1; 95% CI 1.4–3.2) and proteinuria (HR 2.4; 95% CI 1.6–3.7) were independent predictors of the primary outcome. Mesangial Immunoglobulin A deposition did not significantly affect allograft survival. The only significant pathologic factors for the severity of proteinuria were cg and g + ptc (adjusted R2 = 0.46) as determined by multivariable stepwise linear regression analysis. Conclusions: Severe ci + ct and cg at biopsy were predictors of unfavorable allograft prognosis in TG patients even after taking into consideration clinical characteristics. Histologic severity of cg and g + ptc was significantly associated with clinical proteinuria.

scholarly journals The clinicopathologic characteristics of Immunoglobulin A nephropathy related to C3 deposits

2019 ◽  
Author(s):  
Lingzhi Wu ◽  
Di Liu ◽  
Guochun Chen ◽  
Yu Liu ◽  
Jing You ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Proportional Hazards ◽  
Immunoglobulin A ◽  
Cox Proportional Hazards ◽  
Immunoglobulin A Nephropathy ◽  
Proportional Hazards Models ◽  
Renal Outcomes ◽  
Glomerular Capillary ◽  
Cox Proportional Hazards Models ◽  
Mesangial Area

Abstract Background C3 deposits are widely detected in patients with immunoglobulin A nephropathy (IgAN). However, the relationship between the location and intensity of the C3 deposition and prognosis of IgAN is uncertain. Methods 244 patients diagnosed with IgAN were enrolled in our study during 2010- 2016. Patients were divided into groups according to the location of C3 deposits: mesangial area only versus mesangial area and glomerular capillary loops. We also divided those patients into 4 groups according to the intensity of C3 deposition at the base of location. Renal outcomes were end-stage renal disease(ESRD)or a ≥50% reduction in estimated glomerular filtration rate(eGFR), performed by Kaplan–Meier analysis and Cox proportional hazards models. Results Among the 244 recruited patients with IgAN, 139(56.97%) were female. Compared to patients with C3 deposition in the mesangial area only, those with C3 deposition in the mesangial area and glomerular capillary loops had significantly older, lower levels of serum albumin and eGFR, higher levels of uric acid (UA), severe proteinuria, more intense C3 deposits, were more prone to receive corticosteroids and immunosuppression. There were no other significant differences between C3 deposition in the mesangial area only (≤2+ in intensity) group and C3 deposition in the mesangial area and glomerular capillary loops (≤2+ in intensity) group except for age. Patients in C3 deposition in the mesangial area and glomerular capillary loops (>2+ in intensity) group were associated with lower levels of serum albumin, serum IgG and eGFR, higher levels of serum IgM, UA and blood urea nitrogen (BUN),heavier proteinuria and higher interstitial fibrosis/tubular atrophy scores than C3 deposition in the mesangial area deposits only(>2+ in intensity) group. After a median follow-up of 41.86 months,28(11.48%) patients reached the renal outcomes. Higher intensity of C3 deposition in the mesangial area and glomerular capillary loops (95%CI:1.262-76.832, p=0.029) remained an independent risk factor of renal outcomes by multivariate Cox proportional hazards models. Conclusions IgAN patients who had glomerular capillary loops C3 deposits had worse clinical outcomes. Furthermore, the effect of the C3 deposition site on IgA nephropathy is affected by the intensity of C3 deposits.

scholarly journals Prognostic Significance of Chronic Kidney Disease (CKD-EPI Equation) and Anemia in Patients with Chronic Heart Failure Secondary to Chagas Cardiomyopathy

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Marcelo Arruda Nakazone ◽  
Maurício Nassau Machado ◽  
Ana Paula Otaviano ◽  
Ana Maria Silveira Rodrigues ◽  
Augusto Cardinalli-Neto ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Proportional Hazards ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Disease Epidemiology ◽  
Chagas Cardiomyopathy ◽  
Cox Proportional Hazards Models

Background. Few studies regarding chronic kidney disease (CKD) and anemia have been conducted in patients with Chagas cardiomyopathy (CC). We evaluated the risk prediction performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and anemia in CC patients. Methods. From 2000 to 2010, a total of 232 patients were studied in a single-center retrospective study. CKD was defined as creatinine clearance <60 mL/min/1.73 m2 according to CKD-EPI equation. Anemia was defined as hemoglobin <12 g/dL (women) and <13 g/dL (men). Cox proportional hazards models were used to establish predictors for death. Results. At baseline, 98 individuals (42.2%) had criteria for CKD and 41 (17.7%) for anemia. During follow-up, 136 patients (58.6%) died. Independently, CKD and anemia were not associated with all-cause mortality. However, when they coexisted, an additional risk was attributed for these patients. Cox proportional hazard models analysis identified systolic blood pressure (hazard ratio, 0.99; 95% confidence interval (CI), 0.98 to 1.00; P=0.015), implantable cardioverter-defibrillator (hazard ratio, 0.48; 95% CI, 0.27 to 0.85; P=0.012), left anterior fascicular block (hazard ratio, 1.52; 95% CI, 1.08 to 2.13; P=0.017), left ventricular end-diastolic diameter (hazard ratio, 1.04; 95% CI, 1.02 to 1.06; P<0.001), and serum sodium (hazard ratio, 0.95; 95% CI, 0.92 to 0.99; P=0.020) as independent predictors for death. Conclusions. CKD and anemia are not independent predictors for long-term mortality in CC patients. However, the prognosis is poorer in individuals with both comorbidities.

scholarly journals Prognostic significance of low TSH concentration in patients with COVID-19 presenting with non-thyroidal illness syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing Gong ◽  
Ding-kun Wang ◽  
Hui Dong ◽  
Qing-song Xia ◽  
Zhao-yi Huang ◽  
...  
Keyword(s):  
Critical Illness ◽  
Proportional Hazards ◽  
Prognostic Significance ◽  
Laboratory Data ◽  
Thyroid Stimulating Hormone ◽  
Cox Proportional Hazards ◽  
Free Triiodothyronine ◽  
Cox Proportional Hazards Models ◽  
Significant Difference ◽  
Tsh Levels

Abstract Background Low free triiodothyronine (FT3) levels are related to a poor prognosis deterioration in patients with COVID-19 presenting with non-thyroidal illness syndrome (NTI). This study was designed to explore whether free thyroxin (FT4) or thyroid stimulating hormone (TSH) levels affected the mortality of patients with COVID-19 presenting with NTI. Methods Patients with COVID-19 complicated with NTI who were treated at our hospital were included in this retrospective study. Patients were divided into low TSH and normal TSH groups, as well as low and normal-high FT4 group, according to the reference range of TSH or FT4 levels. The 90-day mortality and critical illness rates were compared among patients with low and normal TSH levels, as well as among patients with low FT4 levels and normal-high FT4 levels; in addition, differences in demographic and laboratory data were compared. A Kaplan-Meier analysis and Cox proportional hazards models were used to assess the associations of TSH and FT4 levels with mortality. Results One hundred fifty patients with low FT3 levels and without a history of thyroid disease were included, 68% of whom had normal FT4 and TSH levels. Critical illness rates (74.07% VS 37.40%, P = 0.001) and mortality rates (51.85% VS 22.76%, P = 0.002) were significantly higher in the low TSH group than in the normal TSH group. Although no significant difference in the critical illness rate was found (P = 0.296), the mortality rate was significantly higher in the low FT4 group (P = 0.038). Low TSH levels were independently related to 90-day mortality (hazard ratio = 2.78, 95% CI:1.42–5.552, P = 0.003). Conclusions Low FT4 and TSH concentrations were associated with mortality in patients with COVID-19 presenting with NTI; moreover, low TSH levels were an independent risk factor for mortality in these patients.

Plasma cell-free DNA (cfDNA) profiling of copy number variation (CNV) to identify poor prognostic biomarkers in metastatic castration-resistant prostate cancer (mCRPC).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 176-176
Author(s):  
Edmond Michael Kwan ◽  
Heidi Fettke ◽  
Patricia Bukczynska ◽  
Nicole Ng ◽  
Christine Hauser ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Prognostic Significance ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Castration Resistant Prostate Cancer ◽  
Pten Loss ◽  
Cox Proportional Hazards Models ◽  
Taxane Chemotherapy ◽  
Independent Cohort

176 Background: Multiple tumour tissue studies have demonstrated the prognostic utility of CNVs in mCRPC. However, accurate assessment of CNVs in plasma cfDNA remains challenging, and prognostic significance has not been well characterized. Using a large customized panel, we correlated plasma CNVs with clinical outcomes in a contemporary cohort of mCRPC patients. Methods: Deep targeted sequencing was performed using a 180-gene cfDNA panel (Predicine) in 56 patients commencing AR pathway inhibitors (enzalutamide or abiraterone; n = 34) or taxane chemotherapy (n = 22) at two Australian institutions. Kaplan-Meier estimates and Cox proportional-hazards models were used to correlate CNVs with progression-free survival (PFS) and overall survival (OS). Significant results were validated in an independent cohort (Mayo Clinic, n = 144). Results: Median follow-up was 19.4 months (mo; IQR 11.3-31.9). The most common CNVs in the Australian cohort are shown (Table). OS was significantly decreased in patients with PI3KCA gain (median 21.7 mo vs 6.6 mo, p < 0.0001), PTEN loss (24.8 mo vs 11.7 mo, p = 0.0019) and AR gain (21.7 mo vs 12.0 mo, p = 0.0083). Furthermore, all three alterations independently predicted for poor survival in multivariable analyses (MVA; Table). Findings in the independent cohort showed similar OS results in MVA: PIK3CA gain (HR 2.0, p = 0.07), PTEN loss (HR 1.7, p = 0.08) and AR gain (HR 1.7, p = 0.03). Conclusions: Sequencing of plasma cfDNA revealed that PTEN loss, and PIK3CA and AR gain are associated with inferior clinical outcomes in patients commencing contemporary systemic treatment. These data support therapeutic strategies co-targeting the PI3K and AR pathways in mCRPC.[Table: see text]

scholarly journals Effect of zinc deficiency on chronic kidney disease progression and effect modification by hypoalbuminemia

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251554
Author(s):  
Atsuyuki Tokuyama ◽  
Eiichiro Kanda ◽  
Seiji Itano ◽  
Megumi Kondo ◽  
Yoshihisa Wada ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Zinc Deficiency ◽  
Primary Outcome ◽  
Proportional Hazards ◽  
Serum Zinc ◽  
Cox Proportional Hazards ◽  
Ckd Progression ◽  
Cox Proportional Hazards Models ◽  
End Stage

Serum zinc (Zn) levels tend to be low in chronic kidney disease (CKD) patients. This cohort study was conducted to investigate the relationship between zinc deficiency and CKD progression. Patients were classified into two groups based on Zn levels < 60 μg/dl (low-Zn group, n = 160) and ≥ 60 μg/dl (high-Zn group, n = 152). The primary outcome was defined as end-stage kidney disease (ESKD) or death and was examined over a 1-year observation period. Overall, the mean Zn level was 59.6 μg/dl and the median eGFR was 20.3 ml/min/1.73 m2. The incidence of the primary outcome was higher in the low-Zn group (p<0.001). Various Cox proportional hazards models adjusted for baseline characteristics showed higher risks of the primary outcome in the low-Zn group than in the high-Zn group. Competing risks analysis showed that low Zn levels were associated with ESKD but not with death. Moreover, in propensity score-matched analysis, the low-Zn group showed a higher risk of the primary outcome [adjusted hazard ratio 1.81 (95% confidence interval 1.02, 3.24)]. Furthermore, an interaction was observed between Zn and serum albumin levels (interaction p = 0.026). The results of this study indicate that zinc deficiency is a risk factor for CKD progression.

Ablation for hepatocellular carcinoma: Validating the 3-cm breakpoint.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 277-277
Author(s):  
Ryan Thomas Groeschl ◽  
T. Clark Gamblin ◽  
Kiran Turaga
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Size ◽  
Proportional Hazards ◽  
Prognostic Significance ◽  
Study Groups ◽  
Cox Proportional Hazards ◽  
Rank Tests ◽  
Local Ablation ◽  
Cox Proportional Hazards Models ◽  
Confounding Variables

277 Background: Although many previous studies on ablation outcomes for hepatocellular carcinoma (HCC) have dichotomized tumor size around a 3cm cutoff to determine prognostic significance, a growing number of reports describe excellent outcomes for larger tumors. To address the sensibility of this somewhat arbitrary 3-cm cutoff, we stratified patients by 1cm tumor size intervals and hypothesized that disease-specific survival (DSS) would not vary significantly between adjacent groups. Methods: Patients treated with local ablation for T1 HCC (≤8cm) were identified from the Surveillance, Epidemiology, and End Results database (2004-2008). Log-rank tests were used to compare DSS curves of adjacent study groups, and multivariable Cox proportional hazards models were used adjust for confounding variables. Results: There were 1,093 patients included in the study (26% female, median age: 62 years). The 3-year DSS was significantly lower in patients with 3-4cm tumors compared to 2-3cm tumors (58% vs 72%, p=0.002, Table). In adjusted models, DSS did not vary significantly between any size intervals up to 3cm. Patients with 3-4cm tumors, however, had a poorer prognosis compared to patients with 2-3cm tumors (hazard ratio: 1.60, 95% confidence interval: 1.18-2.18, p=0.002). DSS also fell significantly when tumor size increased from 5-6cm to 6-7cm (53% vs 21%, 0.006). Age and alpha-fetoprotein levels were also independently predictive of DSS in most multivariable models; however, the presence or absence of cirrhosis was not predictive in any models (smallest p=0.382). Conclusions: This study defends the use of a 3cm breakpoint when studying outcomes after ablation for HCC. Although some have advocated that ablation is more successful in cirrhotics, we found no evidence for this in our study. [Table: see text]

Abstract P087: Goldberger's Electrocardiographic Criteria For Left Ventricular Dysfunction Associated With Increased Mortality

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Kang Rui Xiang ◽  
Elsayed Z Soliman ◽  
Prashant Bhave ◽  
Matthew J Singleton
Keyword(s):  
Left Ventricular Dysfunction ◽  
Cardiovascular Mortality ◽  
Ventricular Dysfunction ◽  
Proportional Hazards ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Poor Outcomes

Goldberger’s Electrocardiographic Criteria for Left Ventricular Dysfunction Associated with Increased Mortality Introduction: The ability of the Goldberger electrocardiographic (ECG) triad criteria to detect left ventricular dysfunction (LVD) is well-established. However, the prognostic significance of this triad as a predictor of poor outcomes is not known. Hypothesis: We hypothesized that the Goldberger ECG-LVD triad is associated with increased all-cause mortality and cardiovascular mortality in the general population. Methods: This analysis included 8,426 participants (60.5 ± 13.6 years, 51.5% women, 50% non-Hispanic white) from the Third National Health and Nutrition Examination Survey. The Goldberger ECG-LVD triad was defined as follows: high precordial QRS voltage (SV1 or SV2 + RV5 or RV6 ≥3500 μV); low limb lead QRS voltage (mean QRS amplitude in each of the limb leads ≤ 800 μV); and poor R wave progression (RV4/SV4 <1). Mortality was ascertained using the National Death Index. Results: At baseline, 1,384 (47.3%) of the participants had at least one of the criteria of Goldberger triad (1,193 had only one and 191 participants had 2 or more). During a median follow up of 13.8 years, 3,184 deaths occurred, of which 1,405 were cardiovascular. In multivariable-adjusted Cox proportional hazards models, presence of at least one of the Goldberger triad criteria (vs. none) was associated with increased risk of all-cause (HR 1.17, 95% CI 1.08 – 1.26, p = <0.0001) and cardiovascular mortality (1.19, 1.06 – 1.33, p = 0.003). Conclusion: The Goldberger ECG-LVD triad for left ventricular dysfunction is associated with increased all-cause and cardiovascular mortality and may offer prognostic value, in addition to its diagnostic utility.

The Association of Low Hemoglobin Levels with IgA Nephropathy Progression: A Two-Center Cohort Study of 1,828 Cases

2020 ◽  
Vol 51 (8) ◽  
pp. 624-634 ◽  
Author(s):  
Bin Zhu ◽  
Wen-hua Liu ◽  
Dong-rong Yu ◽  
Yi Lin ◽  
Qiang Li ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Kidney Failure ◽  
Primary Outcome ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Logistic Regression Models ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Poor Outcomes ◽  
Adjusted Model

Aim: To investigate the relationship between hemoglobin levels and the progression of IgA nephropathy (IgAN). Methods: In a two-center cohort of 1,828 cases with biopsy-proven IgAN, we examined the association of hemoglobin levels with the primary outcome of a composite of all-cause mortality or kidney failure defined as a 40% decline in eGFR, or ESKD (defined as eGFR <15 mL/min/1.73 m2 or need for kidney replacement therapy including hemodialysis, peritoneal dialysis, or kidney transplantation), or the outcome of kidney failure, assessed using Cox and logistic regression models, respectively, with adjustment for confounders. Results: At baseline, mean age, eGFR, and hemoglobin levels were 33.75 ± 11.03 years, 99.70 ± 30.40 mL/min/1.73 m2, and 123.47 ± 18.36 g/L, respectively. During a median of approximately 7-year follow-up, 183 cases reached the composite outcome. After adjustment for demographic and IgAN-specific covariates and treatments, a lower quartile of hemoglobin was nonlinearly associated with an increased risk of the primary outcome or kidney failure in the Cox proportional hazards models (primary outcome: HR for quartile 3 vs. 4, 1.37; 95% CI, 0.83–2.25; HR for quartile 2 vs. 4, 1.18; 95% CI, 0.68–2.07; HR for quartile 1 vs. 4, 1.91; 95% CI, 1.15–3.17; kidney failure: HR for quartile 3 vs. 4, 1.39; 95% CI, 0.84–2.31; HR for quartile 2 vs. 4, 1.20; 95% CI, 0.68–2.11; HR for quartile 1 vs. 4, 1.83; 95% CI, 1.09–3.07) in the fully adjusted model. Then, hemoglobin levels were transformed to a binary variable for fitting the model according to the criteria for anemia of 110 g/L in the women and 120 g/L in men in China. The participants in the anemia group had an increased risk of developing outcomes compared with the nonanemia group in both genders (primary outcome: male: HR, 1.64; 95% CI, 1.01–2.68; female: HR, 1.68; 95% CI, 1.02–2.76; kidney failure: male: HR, 1.60; 95% CI, 0.97–2.64; female: HR, 1.58; 95% CI, 0.95–2.61) in the fully adjusted model. Conclusions: A low level of hemoglobin was nonlinearly associated with IgAN progression. The anemic IgAN patients presented a higher risk of developing poor outcomes compared with the nonanemic patients.

Prognostic Utility of the Braden Scale and the Morse Fall Scale in Hospitalized Patients With Heart Failure

2016 ◽  
Vol 39 (4) ◽  
pp. 507-523 ◽  
Author(s):  
Matthew Carazo ◽  
Tina Sadarangani ◽  
Sundar Natarajan ◽  
Stuart D. Katz ◽  
Caroline Blaum ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Outcome ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Geriatric Syndromes ◽  
Cox Proportional Hazards Models ◽  
Braden Scale ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Prognostic Utility

Geriatric syndromes are common in hospitalized elders with heart failure (HF), but association with clinical outcomes is not well characterized. The purpose of this study ( N = 289) was to assess presence of geriatric syndromes using Joint Commission-mandated measures, the Braden Scale (BS) and Morse Fall Scale (MFS), and to explore prognostic utility in hospitalized HF patients. Data extracted from the electronic medical record included sociodemographics, medications, clinical data, comorbid conditions, and the BS and MFS. The primary outcome of mortality was assessed using Social Security Death Master File. Statistical analysis included Cox proportional hazards models to assess association between BS and MFS scores and all-cause mortality with adjustment for known clinical prognostic factors. Higher risk BS and MFS scores were common in hospitalized HF patients, but were not independent predictors of survival. Further study of the clinical utility of these scores and other measures of geriatric syndromes in HF is warranted.

scholarly journals A semi-supervised approach for rapidly creating clinical biomarker phenotypes in the UK Biobank using different primary care EHR and clinical terminology systems

JAMIA Open ◽  
2020 ◽  
Author(s):  
Spiros Denaxas ◽  
Anoop D Shah ◽  
Bilal A Mateen ◽  
Valerie Kuan ◽  
Jennifer K Quint ◽  
...  
Keyword(s):  
Primary Care ◽  
Proportional Hazards ◽  
Biomarker Discovery ◽  
Data Extraction ◽  
Cox Proportional Hazards ◽  
Research Quality ◽  
Uk Biobank ◽  
Expert Review ◽  
Cox Proportional Hazards Models ◽  
The Uk

Abstract Objectives The UK Biobank (UKB) is making primary care electronic health records (EHRs) for 500 000 participants available for COVID-19-related research. Data are extracted from four sources, recorded using five clinical terminologies and stored in different schemas. The aims of our research were to: (a) develop a semi-supervised approach for bootstrapping EHR phenotyping algorithms in UKB EHR, and (b) to evaluate our approach by implementing and evaluating phenotypes for 31 common biomarkers. Materials and Methods We describe an algorithmic approach to phenotyping biomarkers in primary care EHR involving (a) bootstrapping definitions using existing phenotypes, (b) excluding generic, rare, or semantically distant terms, (c) forward-mapping terminology terms, (d) expert review, and (e) data extraction. We evaluated the phenotypes by assessing the ability to reproduce known epidemiological associations with all-cause mortality using Cox proportional hazards models. Results We created and evaluated phenotyping algorithms for 31 biomarkers many of which are directly related to COVID-19 complications, for example diabetes, cardiovascular disease, respiratory disease. Our algorithm identified 1651 Read v2 and Clinical Terms Version 3 terms and automatically excluded 1228 terms. Clinical review excluded 103 terms and included 44 terms, resulting in 364 terms for data extraction (sensitivity 0.89, specificity 0.92). We extracted 38 190 682 events and identified 220 978 participants with at least one biomarker measured. Discussion and conclusion Bootstrapping phenotyping algorithms from similar EHR can potentially address pre-existing methodological concerns that undermine the outputs of biomarker discovery pipelines and provide research-quality phenotyping algorithms.

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