Validation of a hierarchical algorithm to define chronic liver disease and cirrhosis etiology in administrative healthcare data

• Published in: PloS one Vol. 15; no. 2; p. e0229218
• Main Authors: Philip, George, Djerboua, Maya, Carlone, David, Flemming, Jennifer A.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18.02.2020; Public Library of Science (PLoS)
• Subjects: Alcohol; Algorithms; Ambulatory care; Autoimmune diseases; Biology and life sciences; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - etiology; Cirrhosis; Clinical Coding; Clinical medicine; Codes; Cohort Studies; Databases, Factual; Death; Development and progression; Diagnostic systems; Diseases; Electronic Health Records - statistics & numerical data; Emergency medical care; Epidemiology; Etiology; Etiology (Medicine); Fatty liver; Female; Health care; Health care policy; Health sciences; Health services; Hemochromatosis; Hepatitis; Hepatitis - diagnosis; Hepatitis - etiology; Hepatitis B; Hepatitis C; Hepatitis C virus; Hepatology; Humans; Information systems; Laboratories; Liver; Liver cirrhosis; Liver Cirrhosis - diagnosis; Liver Cirrhosis - etiology; Liver diseases; Liver Neoplasms - diagnosis; Liver Neoplasms - etiology; Lung diseases; Male; Medical care quality; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Non-alcoholic Fatty Liver Disease - diagnosis; Non-alcoholic Fatty Liver Disease - etiology; Patients; Privacy; Prognosis; Public health; Sensitivity analysis; Canada; Ontario; Ontario Canada; North America
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0229218

Chronic liver disease (CLD) and cirrhosis are leading causes of death globally with the burden of disease rising significantly over the past several decades. Defining the etiology of liver disease is important for understanding liver disease epidemiology, healthcare planning, and outcomes. The aim of this study was to validate a hierarchical algorithm for CLD and cirrhosis etiology in administrative healthcare data. Consecutive patients with CLD or cirrhosis attending an outpatient hepatology clinic in Ontario, Canada from 05/01/2013-08/31/2013 underwent detailed chart abstraction. Gold standard liver disease etiology was determined by an attending hepatologist as hepatitis C (HCV), hepatitis B (HBV), alcohol-related, non-alcoholic fatty liver disease (NAFLD)/cryptogenic, autoimmune or hemochromatosis. Individual data was linked to routinely collected administrative healthcare data at ICES. Diagnostic accuracy of a hierarchical algorithm incorporating both laboratory and administrative codes to define etiology was evaluated by calculating sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and kappa's agreement. 442 individuals underwent chart abstraction (median age 53 years, 53% cirrhosis, 45% HCV, 26% NAFLD, 10% alcohol-related). In patients with cirrhosis, the algorithm had adequate sensitivity/PPV (>75%) and excellent specificity/NPV (>90%) for all etiologies. In those without cirrhosis, the algorithm was excellent for all etiologies except for hemochromatosis and autoimmune diseases. A hierarchical algorithm incorporating laboratory and administrative coding can accurately define cirrhosis etiology in routinely collected healthcare data. These results should facilitate health services research in this growing patient population.