Validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in England: an observational study

Driver, Rosalind; Balachandrakumar, Vinay; Burton, Anya; Shearer, Jessica; Downing, Amy; Cross, Tim; Morris, Eva; Rowe, Ian

doi:10.1136/bmjopen-2018-028571

Cited by 17 publications

(43 citation statements)

References 22 publications

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“…Diagnosis is more likely to be based on the death certificate only in this category. Additionally, when English data records were linked to hospital episodes statistics data, 25% of other liver tumours were identified as having cirrhosis (compared to 57% of HCCs and 11% % of ICCAs, method detailed in Driver et al (14)). This indicates there are likely to be some HCCs in this category, but this won't account for all unspecified liver tumours.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Primary liver cancer in the UK: Incidence, incidence-based mortality, and survival by subtype, sex, and nation

et al. 2021

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Background & Aims The incidence of primary liver cancer (PLC) is increasing in Western Europe. To understand trends over time and the current burden in the UK, a detailed analysis of the epidemiology of PLC and its subtypes was conducted. Methods Data on PLCs diagnosed during 1997–2017 were obtained from population-based, nationwide registries in the UK. European age-standardised incidence (ASR) and incidence-based mortality rates (ASMR) per 100,000 person-years were calculated overall and by sex and UK-nation. Annual percentage change in rates was estimated using Joinpoint regression. One-, 2-, and 5-year age-standardised net survival was estimated. Results A total of 82,024 PLCs were diagnosed. Both hepatocellular carcinoma (HCC) incidence and mortality rates trebled (ASR 1.8–5.5 per 100,000, ASMR 1.3–4.0). The rate of increase appeared to plateau around 2014/2015. Scottish men consistently had the highest HCC incidence rates. PLC survival increased, driven by a substantial increase in the proportion that are HCC (as prognosis is better than other PLCs) and in HCC survival (change in 1-year survival 24–47%). Intrahepatic cholangiocarcinoma was the most common PLC in women and 1-year survival improved from 22.6% to 30.5%. Conclusions PLC incidence has been increasing rapidly but, as most risk factors are modifiable, it is largely a preventable cancer. This rate of increase has slowed in recent years, possibly attributable to effective treatment for hepatitis C. As other risk factors such as obesity and diabetes remain prevalent in the UK, it is unlikely the considerable burden of this disease will abate. While improvements in survival have been made, over half of patients are not alive after 1 year, therefore further progress in prevention, early detection, and treatment innovation are needed. Lay summary Many more people are getting liver cancer, particularly the subtype hepatocellular carcinoma, than 20 years ago. Men in Scotland are most likely to get liver cancer and to die from it. Survival after liver cancer diagnosis is getting longer but still less than half are alive after 1 year.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Primary liver cancer in the UK: Incidence, incidence-based mortality, and survival by subtype, sex, and nation

et al. 2021

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“…We stratified liver disease hospitalisations into four main aetiologies: alcoholic liver disease (ALD), hepatitis B virus (HBV), hepatitis C virus (HCV) and non‐alcoholic fatty liver disease (NAFLD) (Supplementary Material, Technical Appendix). We identified cirrhosis and cirrhosis‐related complications per admission using diagnostic and procedure codes 13‐16 (Tables S2 and S3). Emergency department diagnoses were not considered.…”

Section: Methodsmentioning

confidence: 99%

Internal medicine hospitalisations and liver disease: a comparative disease burden analysis of a multicentre cohort

Roberts

Hansen

Shin

et al. 2021

Aliment Pharmacol Ther

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Summary Background Liver disease is an increasing burden on population health globally. Aims To characterise burden of liver disease among general internal medicine inpatients at seven Toronto‐area hospitals and compare it to other common medical conditions. Methods Data from April 2010 to October 2017 were obtained from hospitals participating in the GEMINI collaborative. Using these cohort data from hospital information systems linked to administrative data, we defined liver disease admissions using most responsible discharge diagnoses categorised according to international classification of diseases, 10th Revision—enhanced Canadian version (ICD‐10‐CA). We identified admissions for heart failure, chronic obstructive pulmonary disease (COPD) and pneumonia as comparators. We calculated standardised mortality ratios (SMRs) as the ratio of observed to expected deaths. Results Among 239 018 discharges, liver disease accounted for 1.7% of most responsible discharge diagnoses. Liver disease was associated with marked premature mortality, with SMR of 8.84 (95% CI 8.06‐9.67) compared to 1.06 (95% CI 0.99‐1.12) for heart failure, 1.05 (95% CI 0.96‐1.15) for COPD and 1.28 (95% CI 1.20‐1.37) for pneumonia. The majority of deaths were among patients younger than 65 years (57.7%) compared to 3.3% in heart failure, 5.6% in COPD and 10.7% in pneumonia. Liver disease patients presented with worse Laboratory‐Based Acute Physiology Scores, were more frequently admitted to the intensive care unit (14.4%), incurred higher average total costs (median $6723 CAD), had higher in‐hospital mortality (11.4%), and were more likely to be a readmission from 30 days prior (19.8%). Non‐alcoholic fatty liver disease admissions increased from 120 in 2011‐2012 to 215 in 2016‐2017 (P < 0.01). Conclusion In Canada's largest urban centre, liver disease admissions resulted in premature morbidity and mortality with higher resource use compared to common cardio‐respiratory conditions. Re‐evaluation of approaches to caring for inpatients with liver disease is timely and justified.

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“…Examples of these are (18,19,34). Results of prior validation studies in hepatology in general suggest that while some diagnoses have a high positive predictive value (PPV), there are several non-specific diagnoses where considerations need to be made.…”

Section: Accepted Articlementioning

confidence: 99%

Administrative Coding in Electronic Health Care Record‐Based Research of NAFLD: An Expert Panel Consensus Statement

Hagström

Adams

Allen³

et al. 2021

Hepatology

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Validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in England: an observational study

Cited by 17 publications

References 22 publications

Primary liver cancer in the UK: Incidence, incidence-based mortality, and survival by subtype, sex, and nation

Primary liver cancer in the UK: Incidence, incidence-based mortality, and survival by subtype, sex, and nation

Internal medicine hospitalisations and liver disease: a comparative disease burden analysis of a multicentre cohort

Administrative Coding in Electronic Health Care Record‐Based Research of NAFLD: An Expert Panel Consensus Statement

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