Validation of a hierarchical algorithm to define chronic liver disease and cirrhosis etiology in administrative healthcare data

Philip, George; Djerboua, Maya; Carlone, David; Flemming, Jennifer A.

doi:10.1371/journal.pone.0229218

Cited by 29 publications

(32 citation statements)

References 15 publications

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“…Algorithms of several ICD codes to identify cirrhosis and decompensation events have been used in many studies [7,13,21,22]. One disadvantage of an algorithm is that patients are only seen once in hospital or who die after receiving only one ICD code might not be identified.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Unfortunately, there are no diagnostic codes for the most common cause of chronic liver disease, nonalcoholic fatty liver disease, in our data sets. ( 35 ) Although concurrent liver diseases could certainly increase the risk of complications, we expect individuals with known liver disease of another etiology to be screened for HBV even earlier in their disease course. Nonetheless, other causes of liver disease could be a source of residual confounding in our study.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Chronic Hepatitis B Pericomplication: Risk factors and Trends Over Time

Lapointe‐Shaw

Chung²,

Holder³

et al. 2021

Hepatology

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Background and Aims Hepatitis B virus (HBV) is a major cause of chronic liver disease, which can progress to cirrhosis, hepatocellular carcinoma, and death. A timely diagnosis allows for antiviral treatment, which can prevent liver‐related complications. Conversely, a late diagnosis signals a missed opportunity for earlier care and treatment. Our objective was to measure the proportion of chronic HBV diagnoses that are made within 6 months of presentation with a liver disease–related complication and examine associated factors and trends over time. Approach and Results We used provincial laboratory data to identify patients with chronic HBV diagnosed from 2003 to 2014. We measured the proportion who experienced a liver disease complication (decompensated cirrhosis, hepatocellular carcinoma, or liver transplant) within ±6 months of their HBV diagnosis date. A multivariable logistic regression model was used to identify factors associated with HBV diagnosis pericomplication. Of 18,434 patients with chronic HBV, 1,279 (6.9%) developed an HBV‐related complication during the follow‐up period. Among these, 570 (44.6%) had a first diagnosis pericomplication. HBV diagnosis pericomplication did not decrease over time and was independently associated with older age at HBV diagnosis, rural residence, alcohol use, and moderate to high levels of comorbidity. Female patients, immigrants, and those with more outpatient physician visits were less likely to have an HBV diagnosis pericomplication. Conclusions A high proportion of patients with HBV‐related complications are first diagnosed with HBV pericomplication. These signal missed opportunities for earlier detection and treatment. Our findings support expansion of HBV screening.

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“…10 Cirrhosis etiology was determined by using a validated hierarchical coding algorithm. 11 In this algorithm, linked viral serology is evaluated first. If the result for hepatitis C virus (HCV) RNA is positive, the etiology is considered HCV.…”

Section: Lay Summarymentioning

confidence: 99%