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. 2012 Jul;21(7):765-769.
doi: 10.1002/pds.3290. Epub 2012 Jun 4.

Validation of three coding algorithms to identify patients with end-stage liver disease in an administrative database

D Goldberg  1 , Jd Lewis, Sd Halpern, Mark Weiner, Vincent Lo Re 3rd
Affiliations

Validation of three coding algorithms to identify patients with end-stage liver disease in an administrative database

D Goldberg et al. Pharmacoepidemiol Drug Saf. 2012 Jul.

Abstract

PURPOSE: Use of administrative or population-based databases for post-marketing pharmacoepidemiology research in patients with end-stage liver disease (ESLD) has been limited by the difficulty of accurately identifying such patients. Algorithms to identify patients with ESLD using ICD-9-CM codes have not been developed outside of the Veterans Affairs healthcare setting. METHODS: We queried electronic medical records at two tertiary care hospitals to identify patients with ICD-9-CM codes indicative of ESLD. Coding algorithms were developed to identify patients with confirmed ESLD, and these were tested to determine their positive predictive value (PPV). RESULTS: The presence of one inpatient or outpatient ICD-9-CM code for: (i) cirrhosis; (ii) chronic liver disease, and (iii) a hepatic decompensation event yielded a PPV of 85.2% (167/196; 95% CI: 79.4%-89.9%). The PPV increased to 89.3% (150/168; 95% CI: 83.6%-93.5%) when the algorithm required two or more ICD-9-CM codes for a hepatic decompensation. However, an algorithm requiring only one ICD-9-CM code for (i) cirrhosis and (ii) a hepatic decompensation event, in the absence of a chronic liver disease code, yielded a PPV of 85.7% (30/35; 95% CI: 69.7%-95.2%). CONCLUSIONS: A coding algorithm that includes at least one ICD-9-CM code for cirrhosis plus one ICD-9-CM code for a hepatic decompensation event has a high PPV for identifying patients with ESLD. The inclusion of at least two codes indicative of a hepatic decompensation event increased the PPV. This algorithm can be used in future epidemiologic studies to examine the outcomes of a variety of long-term medical therapies in patients with ESLD. Copyright © 2012 John Wiley & Sons, Ltd.

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Conflict of interest statement

Disclosures

The authors of this manuscript have no conflicts of interest to disclose as described by Pharmacoepidemiology and Drug Safety.

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References

    1. Kramer JR, Davila JA, Miller ED, Richardson P, Giordano TP, El-Serag HB. The validity of viral hepatitis and chronic liver disease diagnoses in Veterans Affairs administrative databases. Aliment Pharmacol Ther. 2008;27(3):274–82. Epub 2007/11/13. - PubMed
    1. Lo Re V, 3rd, Lim JK, Goetz MB, Tate J, Bathulapalli H, Klein MB, et al. Validity of diagnostic codes and liver-related laboratory abnormalities to identify hepatic decompensation events in the Veterans Aging Cohort Study. Pharmacoepidemiol Drug Saf. 2011;20(7):689–99. Epub 2011/06/01. - PMC - PubMed
    1. Arvaniti V, D’Amico G, Fede G, Manousou P, Tsochatzis E, Pleguezuelo M, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology. 2010;139(4):1246–56. 56 e1–5. Epub 2010/06/19. - PubMed
    1. Garcia-Tsao G, Friedman S, Iredale J, Pinzani M. Now there are many (stages) where before there was one: In search of a pathophysiological classification of cirrhosis. Hepatology. 2010;51(4):1445–9. Epub 2010/01/16. - PMC - PubMed
    1. Kudo M, Zheng RQ, Kim SR, Okabe Y, Osaki Y, Iijima H, et al. Diagnostic accuracy of imaging for liver cirrhosis compared to histologically proven liver cirrhosis. A multicenter collaborative study. Intervirology. 2008;51(Suppl 1):17–26. Epub 2008/06/27. - PubMed

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