Document Detail

Validity of diagnostic codes and liver-related laboratory abnormalities to identify hepatic decompensation events in the Veterans Aging Cohort Study.
MedLine Citation:
PMID:  21626605     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The absence of validated methods to identify hepatic decompensation in cohort studies has prevented a full understanding of the natural history of chronic liver diseases and impact of medications on this outcome. We determined the ability of diagnostic codes and liver-related laboratory abnormalities to identify hepatic decompensation events within the Veterans Aging Cohort Study (VACS).
METHODS: Medical records of patients with hepatic decompensation codes and/or laboratory abnormalities of liver dysfunction (total bilirubin ≥ 5.0 g/dL, albumin ≤ 2.0 g/dL, INR ≥ 1.7) recorded 1 year before through 6 months after VACS entry were reviewed to identify decompensation events (i.e., ascites, spontaneous bacterial peritonitis, variceal hemorrhage, hepatic encephalopathy, hepatocellular carcinoma) at VACS enrollment. Positive predictive values (PPVs) of diagnostic codes, laboratory abnormalities, and their combinations for confirmed outcomes were determined.
RESULTS: Among 137 patients with a hepatic decompensation code and 197 with a laboratory abnormality, the diagnosis was confirmed in 57 (PPV, 42%; 95%CI, 33%-50%) and 56 (PPV, 28%; 95%CI, 22%-35%) patients, respectively. The combination of any code plus laboratory abnormality increased PPV (64%; 95%CI, 47%-79%). One inpatient or ≥2 outpatient diagnostic codes for ascites, spontaneous bacterial peritonitis, or variceal hemorrhage had high PPV (91%; 95%CI, 77%-98%) for confirmed hepatic decompensation events.
CONCLUSION: An algorithm of 1 inpatient or ≥ 2 outpatient codes for ascites, peritonitis, or variceal hemorrhage has sufficiently high PPV for hepatic decompensation to enable its use for epidemiologic research in VACS. This algorithm may be applicable to other cohorts.
Vincent Lo Re; Joseph K Lim; Matthew Bidwell Goetz; Janet Tate; Harini Bathulapalli; Marina B Klein; David Rimland; Maria C Rodriguez-Barradas; Adeel A Butt; Cynthia L Gibert; Sheldon T Brown; Farah Kidwai; Cynthia Brandt; Zachariah Dorey-Stein; K Rajender Reddy; Amy C Justice
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Validation Studies     Date:  2011-05-27
Journal Detail:
Title:  Pharmacoepidemiology and drug safety     Volume:  20     ISSN:  1099-1557     ISO Abbreviation:  Pharmacoepidemiol Drug Saf     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-29     Completed Date:  2011-10-24     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  9208369     Medline TA:  Pharmacoepidemiol Drug Saf     Country:  England    
Other Details:
Languages:  eng     Pagination:  689-99     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 John Wiley & Sons, Ltd.
Philadelphia VA Medical Center, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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MeSH Terms
Chronic Disease
Cohort Studies
Cross-Sectional Studies
Epidemiologic Methods
International Classification of Diseases
Liver Cirrhosis / complications,  diagnosis*
Liver Diseases / diagnosis*,  physiopathology
Liver Function Tests
Middle Aged
Predictive Value of Tests
Prospective Studies
United States
Grant Support

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