Imputation of missing values for electronic health record laboratory data

• Published in: NPJ digital medicine Vol. 4; no. 1; p. 147
• Main Authors: Li, Jiang, Yan, Xiaowei S., Chaudhary, Durgesh, Avula, Venkatesh, Mudiganti, Satish, Husby, Hannah, Shahjouei, Shima, Afshar, Ardavan, Stewart, Walter F., Yeasin, Mohammed, Zand, Ramin, Abedi, Vida
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 11-10-2021; Nature Publishing Group; Nature Portfolio
• Subjects: 631/114/1305; 631/114/1314; 692/699/75; 692/700/139/1420; Algorithms; Biomedicine; Biotechnology; Comorbidity; Data analysis; Digital technology; Electronic health records; Heart failure; Ischemia; Medical laboratories; Medicine; Medicine & Public Health; Stroke; Variables
• ISSN: 2398-6352; 2398-6352
• DOI: 10.1038/s41746-021-00518-0

Laboratory data from Electronic Health Records (EHR) are often used in prediction models where estimation bias and model performance from missingness can be mitigated using imputation methods. We demonstrate the utility of imputation in two real-world EHR-derived cohorts of ischemic stroke from Geisinger and of heart failure from Sutter Health to: (1) characterize the patterns of missingness in laboratory variables; (2) simulate two missing mechanisms, arbitrary and monotone; (3) compare cross-sectional and multi-level multivariate missing imputation algorithms applied to laboratory data; (4) assess whether incorporation of latent information, derived from comorbidity data, can improve the performance of the algorithms. The latter was based on a case study of hemoglobin A1c under a univariate missing imputation framework. Overall, the pattern of missingness in EHR laboratory variables was
not at random
and was highly associated with patients’ comorbidity data; and the multi-level imputation algorithm showed smaller imputation error than the cross-sectional method.