Identifying cirrhosis, decompensated cirrhosis and hepatocellular carcinoma in health administrative data: A validation study

Lapointe‐Shaw, Lauren; Georgie, Firass; Carlone, David; Cerocchi, Orlando; Chung, Hannah; DeWit, Yvonne; Feld, Jordan J.; Holder, Laura; Kwong, Jeffrey C.; Sander, Beate; Flemming, Jennifer A.

doi:10.1371/journal.pone.0201120

Cited by 88 publications

(118 citation statements)

References 22 publications

(18 reference statements)

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“…Existing evidence shows that ICD-10 coding is valid for defining overall cirrhosis and chronic liver diseases in most of the data sources used to assemble the cause-ofdeath database but does not have the required accuracy for reporting cirrhosis by the five causes estimated in the current study. 23,24 The models that we used to split the parent cirrhosis mortality and morbidity into the five causes are described below.…”

Section: Overviewmentioning

confidence: 99%

The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Sepanlou¹,

Safiri²,

Bisignano³

et al. 2020

The Lancet Gastroenterology & Hepatology

923

528

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Background Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings In 2017, cirrhosis caused more than 1•32 million (95% UI 1•27-1•45) deaths (440 000 [416 000-518 000; 33•3%] in females and 883 000 [838 000-967 000; 66•7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2•4% (2•3-2•6) of total deaths globally in 2017 compared with 1•9% (1•8-2•0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21•0 (19•2-22•3) per 100 000 population in 1990 to 16•5 (15•8-18•1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32•2 [25•8-38•6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10•1 [9•8-10•5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3•7 [3•3-4•0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103•3 [64•4-133•4] per 100 000 in 2017). There were 10•6 million (10•3-10•9) prevalent cases of decompensated cirrhosis and 112 million (107-119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the ot...

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Section: Overviewmentioning

confidence: 99%

The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Sepanlou¹,

Safiri²,

Bisignano³

et al. 2020

The Lancet Gastroenterology & Hepatology

923

528

View full text Add to dashboard Cite

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“…Establishing the validity of ICD codes is therefore needed. Another issue is that previous research has mainly validated ICD codes in small cohorts or cohorts derived from tertiary liver units [12,13], which is likely to suffer from selection bias and has implications on generalisability. Based on these issues, our study aimed to validate and calculate positive predictive values (PPVs) of ICD-10 codes for liver-related events in a nationwide setting.…”

Section: Introductionmentioning

confidence: 99%

Validity of administrative codes associated with cirrhosis in Sweden

Bengtsson

Askling

Ludvigsson

et al. 2020

Scandinavian Journal of Gastroenterology

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Objectives: Although cirrhosisis a major cause of liver-related mortality globally, validation studies of the administrative coding for diagnoses associated with cirrhosis are scarce. We aimed to determine the validity of the International Classification of Diseases, 10th revision (ICD-10) codes corresponding to cirrhosis and its complications in the Swedish National Patient Register (NPR). Methods: We randomly selected 750 patients with ICD codes for either alcohol-related cirrhosis (K70.3), unspecified cirrhosis (K74.6) oesophageal varices (I85.0/I85.9), hepatocellular carcinoma (HCC, C22.0) or ascites (R18.9) registered in the NPR from 72 healthcare centres in 2000-2016. Hospitalisation events and outpatient visits in specialised care were included. Positive predictive values (PPVs) were calculated using the information in the patient charts as the gold standard. Results: Complete data were obtained for 630 (of 750) patients (84%). For alcohol-related cirrhosis, 126/136 cases were correctly coded, corresponding to a PPV of 93% (95% confidence interval, 95%CI: 87-96). The PPV for cirrhosis with unspecified aetiology was 91% (121/133, 95%CI: 85-95) and 96% for oesophageal varices (118/123, 95%CI: 91-99). The PPV was lower for HCC, 84% (91/109, 95%CI: 75-90). The PPV for liver-related ascites was low, 43% (56/129, 95%CI: 35-52), as this category often consisted of non-hepatic ascites. When combining the ascites code with a code for chronic liver disease, the PPV for liver-related ascites increased to 93% (50/54, 95%CI: 82-98). Conclusions: The validity of ICD-10 codes for cirrhosis, oesophageal varices and HCC is high. However, coding for ascites should be combined with a code of chronic liver disease to have an acceptable validity.

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“…These were identified through a combination of administrative data codes for inpatient and outpatient diagnoses and procedures, as well as pathological and death certificate information, as described elsewhere. 8 We followed individuals for outcomes until March 31st 2017.…”

Section: Methods and Resultsmentioning

confidence: 99%