Validating new coding algorithms to improve identification of alcohol-associated and nonalcohol-associated cirrhosis hospitalizations in administrative databases.

IF 5.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Hepatology Communications Pub Date : 2024-06-19 eCollection Date: 2024-07-01 DOI:10.1097/HC9.0000000000000469

Liam A Swain, Jenny Godley, Mayur Brahmania, Juan G Abraldes, Karen L Tang, Jennifer Flemming, Abdel Aziz Shaheen

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引用次数: 0

Abstract

Background: Alcohol (AC) and nonalcohol-associated cirrhosis (NAC) epidemiology studies are limited by available case definitions. We compared the diagnostic accuracy of previous and newly developed case definitions to identify AC and NAC hospitalizations.

Methods: We randomly selected 700 hospitalizations from the 2008 to 2022 Canadian Discharge Abstract Database with alcohol-associated and cirrhosis-related International Classification of Diseases 10th revision codes. We compared standard approaches for AC (ie, AC code alone and alcohol use disorder and nonspecific cirrhosis codes together) and NAC (ie, NAC codes alone) case identification to newly developed approaches that combine standard approaches with new code combinations. Using electronic medical record review as the reference standard, we calculated case definition positive and negative predictive values, sensitivity, specificity, and AUROC.

Results: Electronic medical records were available for 671 admissions; 252 had confirmed AC and 195 NAC. Compared to previous AC definitions, the newly developed algorithm selecting for the AC code, alcohol-associated hepatic failure code, or alcohol use disorder code with a decompensated cirrhosis-related condition or NAC code provided the best overall positive predictive value (91%, 95% CI: 87-95), negative predictive value (89%, CI: 86-92), sensitivity (81%, CI: 76-86), specificity (96%, CI: 93-97), and AUROC (0.88, CI: 0.85-0.91). Comparing all evaluated NAC definitions, high sensitivity (92%, CI: 87-95), specificity (82%, CI: 79-86), negative predictive value (96%, CI: 94-98), AUROC (0.87, CI: 0.84-0.90), but relatively low positive predictive value (68%, CI: 62-74) were obtained by excluding alcohol use disorder codes and using either a NAC code in any diagnostic position or a primary diagnostic code for HCC, unspecified/chronic hepatic failure, esophageal varices without bleeding, or hepatorenal syndrome.

Conclusions: New case definitions show enhanced accuracy for identifying hospitalizations for AC and NAC compared to previously used approaches.

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验证新的编码算法，改进行政数据库中酒精相关性和非酒精相关性肝硬化住院的识别。

背景：酒精（AC）和非酒精相关性肝硬化（NAC）流行病学研究受到现有病例定义的限制。我们比较了以前的病例定义和新开发的病例定义在识别酒精相关性肝硬化和非酒精相关性肝硬化住院病例方面的诊断准确性：我们从 2008 年至 2022 年的加拿大出院摘要数据库中随机选取了 700 例住院病例，这些病例均带有酒精相关和肝硬化相关的《国际疾病分类》第 10 次修订版代码。我们比较了酒精相关（即单独使用酒精相关代码，同时使用酒精使用障碍和非特异性肝硬化代码）和非特异性肝硬化（即单独使用非特异性肝硬化代码）病例识别的标准方法和新开发的将标准方法与新代码组合相结合的方法。以电子病历审查为参考标准，我们计算了病例定义的阳性和阴性预测值、灵敏度、特异性和 AUROC：我们获得了 671 例入院患者的电子病历，其中 252 例确诊为 AC，195 例为 NAC。与之前的 AC 定义相比，新开发的算法在选择 AC 代码、酒精相关肝功能衰竭代码或酒精使用障碍代码时，同时选择失代偿期肝硬化相关病症或 NAC 代码，该算法提供了最佳的总体阳性预测值（91%，95% CI：87-95）、阴性预测值（89%，CI：86-92）、灵敏度（81%，CI：76-86）、特异性（96%，CI：93-97）和 AUROC（0.88，CI：0.85-0.91）。比较所有已评估的 NAC 定义，结果显示，NAC 具有较高的灵敏度（92%，CI：87-95）、特异性（82%，CI：79-86）、阴性预测值（96%，CI：94-98）和 AUROC（0.87，CI：0.84-0.90），但阳性预测值相对较低。结论：通过排除酒精使用障碍代码并在任何诊断位置使用 NAC 代码或使用 HCC、未指定/慢性肝功能衰竭、食管静脉曲张（无出血）或肝肾综合征的主要诊断代码，可获得较高的阳性预测值（68%，CI：62-74）：结论：与以前使用的方法相比，新病例定义提高了识别 AC 和 NAC 住院病例的准确性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hepatology Communications GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

8.00

自引率

2.00%

发文量

248

审稿时长

8 weeks

期刊介绍： Hepatology Communications is a peer-reviewed, online-only, open access journal for fast dissemination of high quality basic, translational, and clinical research in hepatology. Hepatology Communications maintains high standard and rigorous peer review. Because of its open access nature, authors retain the copyright to their works, all articles are immediately available and free to read and share, and it is fully compliant with funder and institutional mandates. The journal is committed to fast publication and author satisfaction.