miércoles, 9 de noviembre de 2016

Validity of diagnostic codes and laboratory tests of liver dysfunction to identify acute liver failure events. - PubMed - NCBI

Validity of diagnostic codes and laboratory tests of liver dysfunction to identify acute liver failure events. - PubMed - NCBI
 2015 Jul;24(7):676-83. doi: 10.1002/pds.3774. Epub 2015 Apr 10.

Validity of diagnostic codes and laboratory tests of liver dysfunction to identify acute liver failure events.

Lo Re V 3rd1,2,3Carbonari DM2,3Forde KA2,3,4Goldberg D2,3,4Lewis JD2,3,4Haynes K2,3Leidl KB2Reddy RK4Roy J2,3Sha D2Marks AR5Schneider JL5Strom BL2,3,6Corley DA5.

Abstract

PURPOSE:

Identification of acute liver failure (ALF) is important for post-marketing surveillance of medications, but the validity of using ICD-9 diagnoses and laboratory data to identify these events within electronic health records is unknown. We examined positive predictive values (PPVs) of hospital ICD-9 diagnoses and laboratory tests of liver dysfunction for identifying ALF within a large, community-based integrated care organization.

METHODS:

We identified Kaiser Permanente Northern California health plan members (2004-2010) with a hospital diagnosis suggesting ALF (ICD-9 570, 572.2, 572.4, 572.8, 573.3, 573.8, or V42.7) plus an inpatient international normalized ratio ≥1.5 (off warfarin) and total bilirubin ≥5.0 mg/dL. Hospital records were reviewed by hepatologists to adjudicate ALF events. PPVs for confirmed outcomes were determined for individual ICD-9 diagnoses, diagnoses plus prescriptions for hepatic encephalopathy treatment, and combinations of diagnoses in the setting of coagulopathy and hyperbilirubinemia.

RESULTS:

Among 669 members with no pre-existing liver disease, chart review confirmed ALF in 62 (9%). Despite the presence of co-existing coagulopathy and hyperbilirubinemia, individual ICD-9 diagnoses had low PPVs (range, 5-15%); requiring prescriptions for encephalopathy treatment did not increase PPVs of these diagnoses (range, 2-23%). Hospital diagnoses of other liver disorders (ICD-9 573.8) plus hepatic coma (ICD-9 572.2) had high PPV (67%; 95%CI, 9-99%) but only identified two (3%) ALF events.

CONCLUSIONS:

Algorithms comprising relevant hospital diagnoses, laboratory evidence of liver dysfunction, and prescriptions for hepatic encephalopathy treatment had low PPVs for confirmed ALF events. Studies of ALF will need to rely on medical records to confirm this outcome.

KEYWORDS:

ICD-9 codes; acute liver failure; hepatotoxicity; liver injury; pharmacoepidemiology; validity
PMID:
 
25866286
 
PMCID:
 
PMC4509617
 
DOI:
 
10.1002/pds.3774
[PubMed - indexed for MEDLINE] 
Free PMC Article