Detecting non-alcoholic fatty liver disease and risk factors in health databases: accuracy and limitations of the ICD-10-AM

Hayward, Kelly L.; Johnson, A. G.; Horsfall, Leigh; Moser, Chris; Valery, Patricia C.; Powell, Elizabeth E.

doi:10.1136/bmjgast-2020-000572

Cited by 31 publications

(36 citation statements)

References 26 publications

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“…Reliance on a single hospital ICD code for cirrhosis, although specific, has been shown to have a sensitivity of only 57%–77% (31). Similarly, ICD-10 codes for NAFLD or nonalcoholic steatohepatitis may underestimate prevalence by 43%–45% (32). Because we have shown NAFLD to be the most common cause of cirrhosis in pregnancy (10), our current findings undoubtedly reflect an underestimation of true disease.…”

Section: Discussionmentioning

confidence: 99%

Pregnancies With Cirrhosis Are Rising and Associated With Adverse Maternal and Perinatal Outcomes

et al. 2021

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INTRODUCTION:Cirrhosis incidence in pregnancies from outside the United States (US) is rising, although contemporary data including maternal and perinatal outcomes within the United States are lacking.Methods:Using discharge data from the racially diverse US National Inpatient Sample, temporal trends of cirrhosis in pregnancies were compared with noncirrhotic chronic liver disease (CLD) or no CLD. Outcomes included preterm birth, postpartum hemorrhage, hypertensive complications (preeclampsia, eclampsia, and/or hemolysis, elevated liver enzymes, and low platelets syndrome), and maternal or fetal death. Logistic regression was adjusted for age, race, multiple gestation, insurance status, and prepregnancy metabolic comorbidities.Results:Among 18,573,000 deliveries from 2012 to 2016, 895 had cirrhosis, 119,875 had noncirrhotic CLD, and 18,452,230 had no CLD. Pregnancies with cirrhosis increased from 2.5/100,000 in 2007 to 6.5/100,000 in 2016 (P = 0.01). On adjusted analysis, cirrhosis was associated with hypertensive complications (vs no CLD, OR 4.9, 95% confidence intervals [CI] 3.3–7.4; vs noncirrhotic CLD, OR 4.4, 95% CI 3.0–6.7), postpartum hemorrhage (vs no CLD, OR 2.8, 95% CI 1.6–4.8; vs noncirrhotic CLD, OR 2.0, 95% CI 1.2–3.5), and preterm birth (vs no CLD, OR 3.1, 95% CI 1.9–4.9; vs noncirrhotic CLD, OR 2.0, 95% CI 1.3–3.3, P ≤ 0.01). Cirrhosis was statistically associated with maternal mortality, although rarely occurred (≤ 1%).DISCUSSION:In this racially diverse, US population-based study, pregnancies with cirrhosis more than doubled over the past decade. Cirrhosis conferred an increased risk of several adverse events, although maternal and perinatal mortality was uncommon. These data underscore the need for reproductive counseling and multidisciplinary pregnancy management in young women with cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Pregnancies With Cirrhosis Are Rising and Associated With Adverse Maternal and Perinatal Outcomes

et al. 2021

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“…Non-alcoholic fatty liver disease (NAFLD) is an umbrella term frequently mentioned to cover a group of hepatic manifestations of non-alcoholic fatty liver (NAFL), non-alcoholic steatohepatitis (NASH), and NASH-related fibrosis [ 1 ]. Using the International Classification of Diseases, tenth revision (ICD-10) published by the World Health Organization (WHO) in 2019, three codes of K76.0 (Fatty (change of) liver, not elsewhere classified), K75.8 (other specified inflammatory liver diseases (NASH), and K74 (Fibrosis and cirrhosis of liver) may be commonly selected by clinicians to fill in the electronic medical records of NAFLD patients [ 2 ]. The shift from viral hepatitis to NAFLD in liver diseases is prevalent and is also accelerating.…”

Section: Introductionmentioning

confidence: 99%

Beneficial Activities of Alisma orientale Extract in a Western Diet-Induced Murine Non-Alcoholic Steatohepatitis and Related Fibrosis Model via Regulation of the Hepatic Adiponectin and Farnesoid X Receptor Pathways

et al. 2022

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The hepatic adiponectin and farnesoid X receptor (FXR) signaling pathways play multiple roles in modulating lipid and glucose metabolism, reducing hepatic inflammation and fibrosis, and altering various metabolic targets for the management of non-alcoholic fatty liver disease (NAFLD). Alisma orientale (AO, Ze xie in Chinese and Taeksa in Korean) is an herbal plant whose tubers are enriched with triterpenoids, which have been reported to exhibit various bioactive properties associated with NAFLD. Here, the present study provides a preclinical evaluation of the biological functions and related signaling pathways of AO extract for the treatment of NAFLD in a Western diet (WD)-induced mouse model. The findings showed that AO extract significantly reversed serum markers (liver function, lipid profile, and glucose) and improved histological features in the liver sections of mice fed WD for 52 weeks. In addition, it also reduced hepatic expression of fibrogenic markers in liver tissue and decreased the extent of collagen-positive areas, as well as inhibited F4/80 macrophage aggregation and inflammatory cytokine secretion. The activation of adiponectin and FXR expression in hepatic tissue may be a major mechanistic signaling cascade supporting the promising role of AO in NAFLD pharmacotherapy. Collectively, our results demonstrated that AO extract improves non-alcoholic steatohepatitis (NASH) resolution, particularly with respect to NASH-related fibrosis, along with the regulation of liver enzymes, postprandial hyperglycemia, hyperlipidemia, and weight loss, probably through the modulation of the hepatic adiponectin and FXR pathways.

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“…The availability of comprehensive, longitudinally collected Veterans Health Administration (VA) electronic health records for US Veteran participants in the MVP also makes it a promising resource for precision medicine. However, NAFLD is markedly underdiagnosed clinically due to the invasive nature of the liver biopsy procedure, variable use of imaging modalities and poor sensitivity of international diagnostic codes (ICD) for NAFLD 4,30 . The use of chronic elevation of serum alanine aminotransferase levels (cALT) as a proxy for NAFLD was shown to improve specificity and positive predictive value in the NAFLD diagnostic algorithm within the VA Corporate Data Warehouse 31 .…”

Section: Introductionmentioning

confidence: 99%

A trans-ancestry genome-wide association study of unexplained chronic ALT elevation as a proxy for nonalcoholic fatty liver disease with histological and radiological validation

Vujkovic¹,

Ramdas²,

Lorenz³

et al. 2021

Preprint

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Nonalcoholic fatty liver disease (NAFLD) is a prevalent, heritable trait that can progress to cancer and liver failure. Using our recently developed proxy definition for NAFLD based on chronic liver enzyme elevation without other causes of liver disease or alcohol misuse, we performed a multi-ancestry genome-wide association study in the Million Veteran Program with 90,408 NAFLD cases and 128,187 controls. Seventy-seven loci exceeded genome-wide significance of which 70 were novel, with an additional European-American specific and two African-American specific loci. Twelve of these loci were also significantly associated with quantitative hepatic fat on radiological imaging (n=44,289). Gene prioritization based on coding annotations, gene expression from GTEx, and functional genomic annotation identified candidate genes at 97% of loci. At eight loci, the allele associated with lower gene expression in liver was also associated with reduced risk of NAFLD, suggesting potential therapeutic relevance. Functional genomic annotation and gene-set enrichment demonstrated that associated loci were relevant to liver biology. We expand the catalog of genes influencing NAFLD, and provide a novel resource to understand its disease initiation, progression and therapy.

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Detecting non-alcoholic fatty liver disease and risk factors in health databases: accuracy and limitations of the ICD-10-AM

Cited by 31 publications

References 26 publications

Pregnancies With Cirrhosis Are Rising and Associated With Adverse Maternal and Perinatal Outcomes

Pregnancies With Cirrhosis Are Rising and Associated With Adverse Maternal and Perinatal Outcomes

Beneficial Activities of Alisma orientale Extract in a Western Diet-Induced Murine Non-Alcoholic Steatohepatitis and Related Fibrosis Model via Regulation of the Hepatic Adiponectin and Farnesoid X Receptor Pathways

A trans-ancestry genome-wide association study of unexplained chronic ALT elevation as a proxy for nonalcoholic fatty liver disease with histological and radiological validation

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