Validity of diagnostic codes and liver‐related laboratory abnormalities to identify hepatic decompensation events in the Veterans Aging Cohort Study

作者：Vincent Lo Re, Joseph K. Lim, Matthew Bidwell Goetz, Janet Tate, Harini Bathulapalli, Marina B. Klein, David Rimland, Maria C. Rodriguez‐Barradas, Adeel Ajwad Butt, Cynthia L. Gibert, Sheldon T. Brown, Farah Kidwai, Cynthia Brandt, Zachariah L. Dorey-Stein, K. Rajender Reddy, Amy C. Justice · 发表于：Pharmacoepidemiology and Drug Safety · 年份：2011 · DOI：10.1002/pds.2148 · 被引用次数：154 · 研究领域：Liver Disease and Transplantation、Drug-Induced Hepatotoxicity and Protection、Liver Disease Diagnosis and Treatment

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: ...