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Sarcoidosis and Risk of VTE: Validation With Big Data FREE TO VIEW

Zaid J. Yaqoob, MD; Sadeer G. Al-Kindi, MD; Joe G. Zein, MD, FCCP
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FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aRespiratory Institute, Cleveland Clinic, Cleveland, OH

bDepartment of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH

CORRESPONDENCE TO: Zaid Yaqoob, MD, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195


Copyright 2017, . All Rights Reserved.


Chest. 2017;151(6):1398-1399. doi:10.1016/j.chest.2017.03.022
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Published online

We read with interest the article by Ungprasert et al published in CHEST (February 2017). In it, the authors use data from the Olmsted County population to show that sarcoidosis portends an increased risk of VTE. We congratulate the authors on this very important and well-performed study. However, due to a low prevalence of sarcoidosis, the number of VTE events in their study is very small, reflected by the large CIs. Thus, although the authors clearly show that the risk of VTE is increased in patients with sarcoidosis, the effect size of this risk is less clear.

We attempted to replicate their analysis in a much larger contemporary data set (Explorys, IBM Watson Health). Explorys directly imports data from billing codes and provider diagnoses in the electronic medical records of 26 major health-care systems in all 50 states.

We selected all adults (age ≥ 18 years) who had active medical records between 2013 and 2017. Diagnoses were identified using the Systematized Nomenclature of Medicine codes: sarcoidosis (31541009), DVT (128053003) and pulmonary embolism (PE) (59282003). Risk of VTE was compared between patients with sarcoidosis and all those in the database without a diagnosis of sarcoidosis using logistic regression.

Of 20,661,810 patients in the database, 53,680 had a diagnosis of sarcoidosis (32% > 65 years; 64% female patients, 58% whites). Among those, 2,730 had DVT, 2,310 had PE, and 4,090 had VTE. After adjusting for age, sex, and race, sarcoidosis was associated with increased risk of VTE (OR, 3.35; 95% CI, 3.25-3.46; P < .001), DVT (OR, 3.06; 95% CI, 2.94-3.18; P < .001), and PE (OR, 3.96; 95% CI, 3.80-4.13; P < .001).

Using a much larger cohort of patients, we validate the results published by Ungprasert et al and provide higher accuracy in defining the risk of VTE in sarcoidosis. Our analysis shows the power of “big data” in the era of electronic medical records to provide validation for small observational studies in a real-world population.

References

Ungprasert P. .Crowson C.S. .Matteson E.L. . Association of sarcoidosis with increased risk of VTE: a population-based study, 1976 to 2013. Chest. 2017;151:425-430 [PubMed]journal. [CrossRef] [PubMed]
 
Kaelber D.C. .Foster W. .Gilder J. .et al Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data. J Am Med Inform Assoc. 2012;19:965-972 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Ungprasert P. .Crowson C.S. .Matteson E.L. . Association of sarcoidosis with increased risk of VTE: a population-based study, 1976 to 2013. Chest. 2017;151:425-430 [PubMed]journal. [CrossRef] [PubMed]
 
Kaelber D.C. .Foster W. .Gilder J. .et al Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data. J Am Med Inform Assoc. 2012;19:965-972 [PubMed]journal. [CrossRef] [PubMed]
 
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