Accuracy of International Classification of Diseases-10 Codes for Cirrhosis and Portal Hypertensive Complications

Burkholder, Daniel A.; Moran, Isabel J.; DiBattista, Jacob V.; Lok, Anna S.; Parikh, Neehar D.; Chen, Vincent

doi:10.1007/s10620-021-07282-x

Cited by 15 publications

(11 citation statements)

References 20 publications

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“…The majority of outcomes and comorbidities were diagnosed based on ICD codes 16 (Table S1). For cirrhosis, we demonstrated that the ICD codes used had a positive predictive value (PPV) of 86% 18 . We additionally assessed the sensitivity of ICD codes for cirrhosis and found that 46% of 582 NAFLD patients with evidence of cirrhosis on imaging had at least one ICD code for cirrhosis within 6 months of the imaging with no meaningful differences in sensitivity (41%–51%) or specificity (≥98%) across BMI categories.…”

Section: Methodsmentioning

confidence: 99%

“…For cirrhosis, we demonstrated that the ICD codes used had a positive predictive value (PPV) of 86%. 18 We additionally assessed the sensitivity of ICD codes for cirrhosis and found that 46% of 582 NAFLD patients with evidence of cirrhosis on imaging had at least one ICD code for cirrhosis within 6 months of the imaging with no meaningful differences in sensitivity (41%-51%) or specificity (≥98%) across BMI categories. Previous studies have validated the accuracy of diagnosis of CVD based on ICD codes with PPV greater than 90% [19][20][21] and large epidemiological studies found PPV of 80% for the diagnosis of all malignant tumours…”

Section: Study Outcomes and Variable Definitionsmentioning

confidence: 99%

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Higher mortality among lean patients with non‐alcoholic fatty liver disease despite fewer metabolic comorbidities

Wijarnpreecha

Lundin

Suresh

et al. 2023

Aliment Pharmacol Ther

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Background & Aims: Non-alcoholic fatty liver disease (NAFLD) can develop in individuals who are not overweight. Whether lean persons with NAFLD have lower mortality and lower incidence of cirrhosis, cardiovascular diseases (CVD), diabetes mellitus (DM) and cancer than overweight/obese persons with NAFLD remains inconclusive. We compared mortality and incidence of cirrhosis, CVD, DM and cancer between lean versus non-lean persons with NAFLD.Methods: This is a retrospective study of adults with NAFLD in a single centre from 2012 to 2021. Primary outcomes were mortality and new diagnosis of cirrhosis, CVD, DM and cancer. Outcomes were modelled using competing risk analysis and Cox proportional hazards regression analysis.Results: A total of 18,594 and 13,420 patients were identified for cross-sectional and longitudinal analysis respectively: approximately 11% lean, 25% overweight, 28% class 1 obesity and 35% class 2-3 obesity. The median age was 51.0 years, 54.6% were women. The median follow-up was 49.3 months. Lean patients had lower prevalence of metabolic diseases at baseline and lower incidence of cirrhosis and DM than non-lean patients and no difference in CVD, any cancer or obesity-related cancer during follow-up. However, lean patients had significantly higher mortality with incidence per 1000 person-years of 16.67, 10.11, 7.37 and 8.99, respectively, in lean, overweight, obesity class 1 and obesity class 2-3 groups respectively.Conclusions: Lean patients with NAFLD had higher mortality despite lower incidence of cirrhosis and DM, and similar incidence of CVD and cancer and merit similar if not more attention as non-lean patients with NAFLD.| 1015 WIJARNPREECHA et al. | INTRODUC TI ONNon-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, affecting 25% of the population worldwide, and its clinical burden is expected to rise. 1 NAFLD is strongly associated with obesity and its comorbidities but can also develop in individuals who are not overweight ('lean NAFLD'). 2 The prevalence of NAFLD among lean individuals in the general population is 10%-20% with most studies reported from Asian countries, and the highest prevalence reported in Mexico (37%). [3][4][5][6] NAFLD is associated with a wide spectrum of extrahepatic diseases, such as cardiovascular diseases (CVD), metabolic diseases (diabetes mellitus [DM], hypertension, dyslipidaemia), chronic kidney diseases (CKD) or cancers. 7,8 Several cross-sectional studies have evaluated prevalence of hepatic and extra-hepatic diseases among lean versus obese individuals with NAFLD. A cross-sectional analysis of the TARGET-NASH study cohort with 3386 NAFLD patients in the United States found a lower prevalence of cirrhosis, DM and CVD in lean individuals compared to overweight/obese individuals. 2 Another study from Austria with 4091 NAFLD participants had similar findings with lower prevalence of metabolic diseases (DM, metabolic syndrome, hypertension, dyslipidaemia) and lower Framingham risk score for CVD but no significant differen...

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Section: Methodsmentioning

confidence: 99%

Section: Study Outcomes and Variable Definitionsmentioning

confidence: 99%

Higher mortality among lean patients with non‐alcoholic fatty liver disease despite fewer metabolic comorbidities

Wijarnpreecha

Lundin

Suresh

et al. 2023

Aliment Pharmacol Ther

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“…LRE and CVD outcomes were defined based on validated International Classification of Diseases codes (Table S1). [17][18][19] For all outcomes, we used a landmark of 365 days to reduce immortal time bias and (for the LRE and CVD outcomes) account for delays in diagnosis which might result in incorrect classification as incident LRE/CVD when the patient actually had prevalent disease. We generated multivariable models adjusted for age, sex, race, diabetes, body mass index, hypertension and dyslipidaemia based on causal inference since these variables differed significantly between affluence and disadvantage (Table 1); we did not adjust for laboratory values because of high levels of missingness.…”

Section: Discussionmentioning

confidence: 99%

Effects of social determinants of health on mortality and incident liver‐related events and cardiovascular disease in steatotic liver disease

Chen

Song

Suresh

et al. 2023

Aliment Pharmacol Ther

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SummaryBackgroundSocial determinants of health (SDOH) are becoming increasingly recognised as mediators of human health. In the setting of metabolic dysfunction‐associated steatotic liver disease (MASLD), most of the literature on SDOH relates to individual‐level risk factors. However, there are very limited data on neighbourhood‐level SDOH in MASLD.AimTo assess whether SDOH impact fibrosis progression in patients who already have MASLD.MethodsThis was a retrospective cohort study of patients with MASLD seen at Michigan Medicine. The primary predictors were two neighbourhood‐level SDOH, ‘disadvantage’ and ‘affluence’. The primary outcomes were mortality, incident liver‐related events (LREs) and incident cardiovascular disease (CVD). We modelled these outcomes using Kaplan–Meier statistics for mortality and competing risk analyses for LREs and CVD, using a 1‐year landmark.ResultsWe included 15,904 patients with MASLD with median follow‐up of 63 months. Higher affluence was associated with lower risk of overall mortality (hazard ratio 0.49 [0.37–0.66], p < 0.0001 for higher vs. lower quartile), LREs (subhazard ratio 0.60 [0.39–0.91], p = 0.02) and CVD (subhazard ratio 0.71 [0.57–0.88], p = 0.0018). Disadvantage was associated with higher mortality (hazard ratio 2.08 [95% confidence interval 1.54–2.81], p < 0.0001 for the highest vs. lowest quartile) and incident CVD (subhazard ratio 1.36 [95% confidence interval 1.10–1.68], p < 0.0001). These findings were robust across several sensitivity analyses.DiscussionNeighbourhood‐level SDOH are associated with mortality, incidence of LREs and incident CVD in patients with steatotic liver disease. Interventions aimed at disadvantaged neighbourhoods may improve clinical outcomes.

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“…A retrospective analysis was conducted on 81,554 pregnant women who gave birth at the Third Affiliated Hospital of Sun Yat-sen University between 2010 and 2022. Women with cirrhosis were initially identified according to the International Classification of Diseases , 10th Revision (ICD-10) [ 13 ]. A computer search of these women aimed to identify cases with liver cirrhosis (ICD-10 O26.604, pregnancy with cirrhosis; ICD-10 K74.100, liver cirrhosis; ICD-10 K74.607, decompensated cirrhosis; ICD-10 K74.3, primary biliary cirrhosis; ICD-10 K71.7, drug-induced cirrhosis; ICD-10 K70.3, alcoholic cirrhosis; ICD-10 K74.6, other causes of cirrhosis).…”

Section: Methodsmentioning

confidence: 99%

Outcomes of pregnancies complicated by cirrhosis: a retrospective cohort study

Tan,

Zhang,

Zhou

et al. 2024

BMC Pregnancy Childbirth

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Background Although pregnancy complicated by liver cirrhosis is rare, women with cirrhosis experience increased adverse pregnancy outcomes. This study aimed to evaluate pregnancy outcomes in women with liver cirrhosis and develop a predictive model using maternal factors for preterm birth in such pregnancies. Methods A retrospective analysis was conducted on pregnancy outcomes of a cirrhosis group (n = 43) and a non-cirrhosis group (n = 172) in a university hospital between 2010 and 2022. Logistic regression evaluated pregnancy outcomes, and a forward stepwise logistic regression model was designed to predict preterm birth in pregnant women with cirrhosis. The model's predictive performance was evaluated using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). Results The incidence of cirrhosis during pregnancy was 0.06% (50/81,554). Pregnant women with cirrhosis faced increased risks of cesarean section, preterm birth, intrahepatic cholestasis of pregnancy, thrombocytopenia, and postpartum hemorrhage. In pregnant women with cirrhosis, preterm birth risk significantly increased at an incidence rate of 46.51% (20/43). According to the prediction model, the key predictors of preterm birth in pregnant women with cirrhosis were intrahepatic cholestasis of pregnancy and total bilirubin. The model demonstrated accurate prediction, with an AUC of 0.847, yielding a model accuracy of 81.4%. Conclusions Pregnant women with cirrhosis face a heightened risk of adverse obstetric outcomes, particularly an increased incidence of preterm birth. The preliminary evidence shows that the regression model established in our study can use the identified key predictors to predict preterm birth in pregnant women with cirrhosis, with high accuracy.

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Accuracy of International Classification of Diseases-10 Codes for Cirrhosis and Portal Hypertensive Complications

Cited by 15 publications

References 20 publications

Higher mortality among lean patients with non‐alcoholic fatty liver disease despite fewer metabolic comorbidities

Higher mortality among lean patients with non‐alcoholic fatty liver disease despite fewer metabolic comorbidities

Effects of social determinants of health on mortality and incident liver‐related events and cardiovascular disease in steatotic liver disease

Outcomes of pregnancies complicated by cirrhosis: a retrospective cohort study

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