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  1. Article ; Online: Impact of possible errors in natural language processing-derived data on downstream epidemiologic analysis.

    Lan, Zhou / Turchin, Alexander

    JAMIA open

    2023  Volume 6, Issue 4, Page(s) ooad111

    Abstract: Objective: To assess the impact of potential errors in natural language processing (NLP) on the results of epidemiologic studies.: Materials and methods: We utilized data from three outcomes research studies where the primary predictor variable was ... ...

    Abstract Objective: To assess the impact of potential errors in natural language processing (NLP) on the results of epidemiologic studies.
    Materials and methods: We utilized data from three outcomes research studies where the primary predictor variable was generated using NLP. For each of these studies, Monte Carlo simulations were applied to generate datasets simulating potential errors in NLP-derived variables. We subsequently fit the original regression models to these partially simulated datasets and compared the distribution of coefficient estimates to the original study results.
    Results: Among the four models evaluated, the mean change in the point estimate of the relationship between the predictor variable and the outcome ranged from -21.9% to 4.12%. In three of the four models, significance of this relationship was not eliminated in a single of the 500 simulations, and in one model it was eliminated in 12% of simulations. Mean changes in the estimates for confounder variables ranged from 0.27% to 2.27% and significance of the relationship was eliminated between 0% and 9.25% of the time. No variables underwent a shift in the direction of its interpretation.
    Discussion: Impact of simulated NLP errors on the results of epidemiologic studies was modest, with only small changes in effect estimates and no changes in the interpretation of the findings (direction and significance of association with the outcome) for either the NLP-generated variables or other variables in the models.
    Conclusion: NLP errors are unlikely to affect the results of studies that use NLP as the source of data.
    Language English
    Publishing date 2023-12-27
    Publishing country United States
    Document type Journal Article
    ISSN 2574-2531
    ISSN (online) 2574-2531
    DOI 10.1093/jamiaopen/ooad111
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  2. Article ; Online: Therapeutic inertia in treatment of older adults with type II diabetes at high risk for hypoglycemia.

    Ricci, Brittany / Lee, Jane / Xie, Minjia / Turchin, Alexander

    Primary care diabetes

    2024  Volume 18, Issue 2, Page(s) 238–240

    Abstract: Patients 80 years or older with HbA1c <7.0% (53 mmol/mol) treated with multiple daily insulin injections had low rates of rapid-acting insulin deprescription and initiation of diabetes medications with lower risk of hypoglycemia. Further investigation is ...

    Abstract Patients 80 years or older with HbA1c <7.0% (53 mmol/mol) treated with multiple daily insulin injections had low rates of rapid-acting insulin deprescription and initiation of diabetes medications with lower risk of hypoglycemia. Further investigation is needed to elucidate factors contributing to potentially inappropriately aggressive treatment of these patients.
    MeSH term(s) Humans ; Aged ; Diabetes Mellitus, Type 2/diagnosis ; Diabetes Mellitus, Type 2/drug therapy ; Hypoglycemic Agents/adverse effects ; Blood Glucose ; Glycated Hemoglobin ; Hypoglycemia/chemically induced ; Hypoglycemia/diagnosis ; Insulin/therapeutic use
    Chemical Substances Hypoglycemic Agents ; Blood Glucose ; Glycated Hemoglobin ; Insulin
    Language English
    Publishing date 2024-02-06
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2273997-X
    ISSN 1878-0210 ; 1751-9918
    ISSN (online) 1878-0210
    ISSN 1751-9918
    DOI 10.1016/j.pcd.2024.01.015
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  3. Article ; Online: Using Renin Activity to Guide Mineralocorticoid Receptor Antagonist Therapy in Patients with Low Renin and Hypertension.

    Mansur, Arian / Vaidya, Anand / Turchin, Alexander

    American journal of hypertension

    2023  Volume 36, Issue 8, Page(s) 455–461

    Abstract: Background: Mineralocorticoid receptor antagonists (MRAs) are often empirically used for patients with low-renin hypertension (LRH) or probable primary aldosteronism (PA) who decline surgery. However, the optimal approach to MRA therapy is unknown. ... ...

    Abstract Background: Mineralocorticoid receptor antagonists (MRAs) are often empirically used for patients with low-renin hypertension (LRH) or probable primary aldosteronism (PA) who decline surgery. However, the optimal approach to MRA therapy is unknown. Studies have shown that a rise in renin is an effective biomarker of prevention of cardiovascular complications of PA. This study aimed to determine whether empiric MRA therapy in patients with LRH or probable PA targeting unsuppressed renin is associated with a decrease in blood pressure and/or proteinuria.
    Methods: Retrospective single-center cohort study from 2005 to 2021 included adults with LRH or probable PA (renin activity <1.0 ng/ml/h and detectable aldosterone levels). All patients were empirically treated with an MRA, targeting renin ≥1.0 ng/ml/h.
    Results: Out of 39 patients studied, 32 (82.1%) achieved unsuppressed renin. Systolic and diastolic blood pressure decreased from 148.0 and 81.2 to 125.8 and 71.6 mm Hg, respectively (P < 0.001 for both). Similar blood pressure reductions were seen whether patients had high (>10 ng/dl) or low (<10 ng/dl) aldosterone levels. The majority (24/39; 61.5%) of patients had at least one baseline anti-hypertensive medication stopped. Among the six patients who had detectable proteinuria and albumin-to-creatinine (ACR) measurements post-treatment, the mean ACR decreased from 179.0 to 36.1 mg/g (P = 0.03). None of the patients studied had to completely stop treatment due to adverse reactions.
    Conclusions: Empiric MRA therapy in patients with LRH or probable PA targeting unsuppressed renin can safely and effectively improve blood pressure control and reduce proteinuria.
    MeSH term(s) Adult ; Humans ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Renin ; Aldosterone ; Mineralocorticoids/therapeutic use ; Hyperaldosteronism ; Retrospective Studies ; Cohort Studies ; Hypertension/diagnosis ; Hypertension/drug therapy
    Chemical Substances Mineralocorticoid Receptor Antagonists ; Renin (EC 3.4.23.15) ; Aldosterone (4964P6T9RB) ; Mineralocorticoids
    Language English
    Publishing date 2023-04-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639383-4
    ISSN 1941-7225 ; 1879-1905 ; 0895-7061
    ISSN (online) 1941-7225 ; 1879-1905
    ISSN 0895-7061
    DOI 10.1093/ajh/hpad032
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    Zs.A 2329: Show issues Location:
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  4. Article ; Online: COVID-19 outcomes in patients taking cardioprotective medications.

    Morrison, Fritha J / Su, Maxwell / Turchin, Alexander

    PloS one

    2022  Volume 17, Issue 10, Page(s) e0275787

    Abstract: Introduction: The coronavirus disease 2019 (COVID-19) caused a worldwide pandemic and has led to over five million deaths. Many cardiovascular risk factors (e.g. obesity or diabetes) are associated with an increased risk of adverse outcomes in COVID-19. ...

    Abstract Introduction: The coronavirus disease 2019 (COVID-19) caused a worldwide pandemic and has led to over five million deaths. Many cardiovascular risk factors (e.g. obesity or diabetes) are associated with an increased risk of adverse outcomes in COVID-19. On the other hand, it has been suggested that medications used to treat cardiometabolic conditions may have protective effects for patients with COVID-19.
    Objectives: To determine whether patients taking four classes of cardioprotective medications-aspirin, metformin, renin angiotensin aldosterone system inhibitors (RAASi) and statins-have a lower risk of adverse outcomes of COVID-19.
    Methods: We conducted a retrospective cohort study of primary care patients at a large integrated healthcare delivery system who had a positive COVID-19 test between March 2020 and March 2021. We compared outcomes of patients who were taking one of the study medications at the time of the COVID-19 test to patients who took a medication from the same class in the past (to minimize bias by indication). The following outcomes were compared: a) hospitalization; b) ICU admission; c) intubation; and d) death. Multivariable analysis was used to adjust for patient demographics and comorbidities.
    Results: Among 13,585 study patients, 1,970 (14.5%) were hospitalized; 763 (5.6%) were admitted to an ICU; 373 (2.8%) were intubated and 720 (5.3%) died. In bivariate analyses, patients taking metformin, RAASi and statins had lower risk of hospitalization, ICU admission and death. However, in multivariable analysis, only the lower risk of death remained statistically significant. Patients taking aspirin had a significantly higher risk of hospitalization in both bivariate and multivariable analyses.
    Conclusions: Cardioprotective medications were not associated with a consistent benefit in COVID-19. As vaccination and effective treatments are not yet universally accessible worldwide, research should continue to determine whether affordable and widely available medications could be utilized to decrease the risks of this disease.
    MeSH term(s) Aspirin ; COVID-19/drug therapy ; COVID-19/epidemiology ; Hospitalization ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Metformin ; Retrospective Studies ; SARS-CoV-2
    Chemical Substances Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Metformin (9100L32L2N) ; Aspirin (R16CO5Y76E)
    Language English
    Publishing date 2022-10-10
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0275787
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  5. Article ; Online: Using Natural Language Processing to Measure and Improve Quality of Diabetes Care: A Systematic Review.

    Turchin, Alexander / Florez Builes, Luisa F

    Journal of diabetes science and technology

    2021  Volume 15, Issue 3, Page(s) 553–560

    Abstract: Background: Real-world evidence research plays an increasingly important role in diabetes care. However, a large fraction of real-world data are "locked" in narrative format. Natural language processing (NLP) technology offers a solution for analysis of ...

    Abstract Background: Real-world evidence research plays an increasingly important role in diabetes care. However, a large fraction of real-world data are "locked" in narrative format. Natural language processing (NLP) technology offers a solution for analysis of narrative electronic data.
    Methods: We conducted a systematic review of studies of NLP technology focused on diabetes. Articles published prior to June 2020 were included.
    Results: We included 38 studies in the analysis. The majority (24; 63.2%) described only development of NLP tools; the remainder used NLP tools to conduct clinical research. A large fraction (17; 44.7%) of studies focused on identification of patients with diabetes; the rest covered a broad range of subjects that included hypoglycemia, lifestyle counseling, diabetic kidney disease, insulin therapy and others. The mean F
    Conclusion: Research in NLP technology to study diabetes is growing quickly, although challenges (e.g. in analysis of more linguistically complex concepts) remain. Its potential to deliver evidence on treatment and improving quality of diabetes care is demonstrated by a number of studies. Further growth in this area would be aided by deeper collaboration between developers and end-users of natural language processing tools as well as by broader sharing of the tools themselves and related resources.
    MeSH term(s) Diabetes Mellitus/therapy ; Electronic Health Records ; Humans ; Hypoglycemia ; Natural Language Processing
    Language English
    Publishing date 2021-03-19
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
    ISSN 1932-2968
    ISSN (online) 1932-2968
    DOI 10.1177/19322968211000831
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  6. Article ; Online: Outcomes in patients with cardiometabolic disease who develop hyperkalemia while treated with a renin-angiotensin-aldosterone system inhibitor.

    Johnson, Matthew / Morrison, Fritha J / McMahon, Gearoid / Su, Maxwell / Turchin, Alexander

    American heart journal

    2023  Volume 258, Page(s) 49–59

    Abstract: Background: Many patients with indications for renin-angiotensin-aldosterone system inhibitor (RAASi) therapy are not receiving these medications. Concern about hyperkalemia is thought to contribute to this lack of evidence-based therapy.: Methods: A ...

    Abstract Background: Many patients with indications for renin-angiotensin-aldosterone system inhibitor (RAASi) therapy are not receiving these medications. Concern about hyperkalemia is thought to contribute to this lack of evidence-based therapy.
    Methods: A retrospective cohort study included adult patients in primary care practices affiliated with an integrated health care delivery system treated with RAASi between 2000 and 2019 for any of the following indications: (a) coronary artery disease (CAD); (b) heart failure (HF) with a left ventricle ejection fraction ≤ 40%; (c) diabetes mellitus (DM) with proteinuria; or (d) chronic kidney disease (CKD) with proteinuria. Relationship between hyperkalemia (K > 5.0 mEg/L) over the first 12 months of follow-up and a composite end point of cardiovascular events, renal dysfunction, and all-cause mortality was evaluated.
    Results: Among 82,732 study patients, 7,727 (9.34%) developed hyperkalemia. Patients with hyperkalemia were older (69.0 vs 64.6) and more likely to have CAD (57.8 vs 53.7%), CKD (57.3 vs 51.1%), HF (19.3 vs 9.7%), and DM (45.3 vs 33.3%) (P < .001 for all). Five-year cumulative risk of the primary outcome was higher in patients who did (63.9%; 95% CI: 62.8%-65.1%) versus did not (37.2%; 95% CI: 36.8%-37.6%) develop hyperkalemia. Five-year cumulative risk of ED visit or hospitalization for hyperkalemia was 15.6% (14.7%-16.6%) for patients with versus 2.7% (95% CI: 2.6-2.9) for patients without hyperkalemia, rising to 25.9% (95% CI: 22.4-29.9) for patients with severe (K > 6.0 mEq/dL) hyperkalemia. Patients who experienced hyperkalemia were more likely (34.4%) than patients who did not (29.2%) to deintensify RAASi therapy (P < .001). Five-year cumulative risk of the primary outcome was higher in patients who lowered RAASi dose (50.4%; 95% CI: 48.5%-52.4%) or stopped RAASi therapy completely (49.3%; 95% CI: 48.5%-50.1%), compared to patients who continued RAASi therapy (36.1%; 95% CI: 25.7-36.5). Similar findings were observed in multivariable analyses and for individual components of the primary outcome.
    Conclusions: Hyperkalemia is a common complication of RAASi therapy and is associated with an increased risk of multiple adverse outcomes. Patients who have their RAASi medications deintensified after a hyperkalemic event have higher incidence of cardiovascular events, renal dysfunction and death.
    MeSH term(s) Adult ; Humans ; Renin-Angiotensin System ; Hyperkalemia/chemically induced ; Hyperkalemia/epidemiology ; Angiotensin-Converting Enzyme Inhibitors/adverse effects ; Aldosterone ; Retrospective Studies ; Antihypertensive Agents/therapeutic use ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/drug therapy ; Heart Failure/drug therapy ; Heart Failure/epidemiology ; Heart Failure/complications ; Coronary Artery Disease/complications ; Proteinuria/chemically induced ; Proteinuria/complications ; Proteinuria/drug therapy ; Potassium
    Chemical Substances Angiotensin-Converting Enzyme Inhibitors ; Aldosterone (4964P6T9RB) ; Antihypertensive Agents ; Potassium (RWP5GA015D)
    Language English
    Publishing date 2023-01-13
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80026-0
    ISSN 1097-6744 ; 0002-8703
    ISSN (online) 1097-6744
    ISSN 0002-8703
    DOI 10.1016/j.ahj.2023.01.002
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    Ui IV Zs.15: Show issues Location:
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  7. Article: Correction: Podlutskii et al.

    Podlutskii, Mikhail / Babina, Darya / Podobed, Marina / Bondarenko, Ekaterina / Bitarishvili, Sofia / Blinova, Yana / Shesterikova, Ekaterina / Prazyan, Alexander / Turchin, Larisa / Garbaruk, Dmitrii / Kudin, Maxim / Duarte, Gustavo T / Volkova, Polina

    Plants (Basel, Switzerland)

    2024  Volume 13, Issue 7

    Abstract: In the original publication [ ... ]. ...

    Abstract In the original publication [...].
    Language English
    Publishing date 2024-03-25
    Publishing country Switzerland
    Document type Published Erratum
    ZDB-ID 2704341-1
    ISSN 2223-7747
    ISSN 2223-7747
    DOI 10.3390/plants13070947
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  8. Article ; Online: Natural language processing to phenotype coronary computed tomography angiography: Development, validation, and initial results of a large multi-institution cohort.

    Berman, Adam N / Shiyovich, Arthur / Biery, David W / Cardoso, Rhanderson N / Weber, Brittany N / Petranovic, Milena / Besser, Stephanie A / Hainer, Jon / Wasfy, Jason H / Turchin, Alexander / Di Carli, Marcelo F / Blankstein, Ron / Huck, Daniel M

    Journal of cardiovascular computed tomography

    2024  

    Language English
    Publishing date 2024-03-07
    Publishing country United States
    Document type Letter
    ZDB-ID 2394360-9
    ISSN 1876-861X ; 1934-5925
    ISSN (online) 1876-861X
    ISSN 1934-5925
    DOI 10.1016/j.jcct.2024.03.003
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    Zs.A 6761: Show issues Location:
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  9. Article ; Online: Evaluating the clinical and mechanistic effects of eplerenone and amiloride monotherapy, and combination therapy with cinacalcet, in primary hyperparathyroidism: A placebo-controlled randomized trial.

    Parksook, Wasita W / Heydarpour, Mahyar / Brown, Jenifer M / Turchin, Alexander / Mannstadt, Michael / Vaidya, Anand

    Clinical endocrinology

    2022  Volume 98, Issue 4, Page(s) 516–526

    Abstract: Objectives: Human physiology and epidemiology studies have demonstrated complex interactions between the renin-angiotensin-aldosterone system, parathyroid hormone and calcium homeostasis. Several of these studies have suggested that aldosterone ... ...

    Abstract Objectives: Human physiology and epidemiology studies have demonstrated complex interactions between the renin-angiotensin-aldosterone system, parathyroid hormone and calcium homeostasis. Several of these studies have suggested that aldosterone inhibition may lower parathyroid hormone (PTH) levels. The objective of this study was to assess the effect of 4 weeks of maximally tolerated mineralocorticoid receptor antagonist therapy with eplerenone on PTH levels in patients with primary hyperparathyroidism (P-HPT) when compared to amiloride and placebo. We also investigated the synergistic effect of these interventions when combined with cinacalcet for an additional 2 weeks.
    Design: Randomized, double-blinded, three parallel-group, placebo-controlled trial.
    Patients: Patients with P-HPT.
    Results: Most patients were women (83%) and White (76%). Maximally tolerated doses of eplerenone and amiloride induced significant reductions in blood pressure and increases in renin and aldosterone production; however, despite these physiologic changes, neither intervention induced significant changes in PTH or calcium levels when compared to the placebo. Both eplerenone and amiloride therapy induced significant reductions in procollagen type 1 N-terminal propeptide levels when compared to placebo. When cinacalcet therapy was added, PTH and calcium levels were markedly reduced in all groups; however, there was no significant difference in PTH or serum calcium reductions between groups.
    Conclusions: Although maximally tolerated therapy with eplerenone and amiloride induced expected changes in renin, aldosterone and blood pressure, there were no meaningful changes in PTH or serum calcium levels in P-HPT patients. These results suggest that inhibition of aldosterone action does not have a clinically meaningful role in medical therapy for P-HPT.
    MeSH term(s) Humans ; Female ; Male ; Eplerenone/therapeutic use ; Cinacalcet/pharmacology ; Amiloride/therapeutic use ; Aldosterone ; Calcium ; Renin ; Hyperparathyroidism, Primary ; Parathyroid Hormone
    Chemical Substances Eplerenone (6995V82D0B) ; Cinacalcet (UAZ6V7728S) ; Amiloride (7DZO8EB0Z3) ; Aldosterone (4964P6T9RB) ; Calcium (SY7Q814VUP) ; Renin (EC 3.4.23.15) ; Parathyroid Hormone
    Language English
    Publishing date 2022-11-08
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 121745-8
    ISSN 1365-2265 ; 0300-0664
    ISSN (online) 1365-2265
    ISSN 0300-0664
    DOI 10.1111/cen.14840
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  10. Article ; Online: EXIST: EXamining rIsk of excesS adiposiTy-Machine learning to predict obesity-related complications.

    Turchin, Alexander / Morrison, Fritha J / Shubina, Maria / Lipkovich, Ilya / Shinde, Shraddha / Ahmad, Nadia N / Kan, Hong

    Obesity science & practice

    2023  Volume 10, Issue 1, Page(s) e707

    Abstract: Background: Obesity is associated with an increased risk of multiple conditions, ranging from heart disease to cancer. However, there are few predictive models for these outcomes that have been developed specifically for people with overweight/obesity.!# ...

    Abstract Background: Obesity is associated with an increased risk of multiple conditions, ranging from heart disease to cancer. However, there are few predictive models for these outcomes that have been developed specifically for people with overweight/obesity.
    Objective: To develop predictive models for obesity-related complications in patients with overweight and obesity.
    Methods: Electronic health record data of adults with body mass index 25-80 kg/m
    Results: Over a median follow-up of 5.6 years, study outcome incidence in the cohort of 433,272 patients ranged from 1.8% for knee replacement to 11.7% for atherosclerotic cardiovascular disease. Harrell C-index averaged over replicates ranged from 0.702 for liver outcomes to 0.896 for death for RSF, and from 0.694 for liver outcomes to 0.891 for death for Lasso-Cox. The Harrell C-index for parsimonious models ranged from 0.675 for liver outcomes to 0.850 for knee replacement.
    Conclusions: Predictive modeling can identify patients at high risk of obesity-related complications. Interpretable Cox models achieve results close to those of machine learning methods and could be helpful for population health management and clinical treatment decisions.
    Language English
    Publishing date 2023-09-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2836381-4
    ISSN 2055-2238 ; 2055-2238
    ISSN (online) 2055-2238
    ISSN 2055-2238
    DOI 10.1002/osp4.707
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