Massicotte-Azarniouch David, Sood Manish M, Fergusson Dean A, Knoll Greg A
Department of Medicine, University of Ottawa, ON, Canada.
Division of Nephrology, Kidney Research Center, Department of Medicine, University of Ottawa, ON, Canada.
Can J Kidney Health Dis. 2020 Dec 16;7:2054358120977390. doi: 10.1177/2054358120977390. eCollection 2020.
Clinical research requires that diagnostic codes captured from routinely collected health administrative data accurately identify individuals with a disease.
In this study, we validated the International Classification of Disease 10th Revision (ICD-10) definition for kidney transplant rejection (T86.100) and for kidney transplant failure (T86.101).
Retrospective cohort study.
A large, regional transplantation center in Ontario, Canada.
All adult kidney transplant recipients from 2002 to 2018.
Chart review was undertaken to identify the first occurrence of biopsy-confirmed rejection and graft loss for all participants. For each observation, we determined the first date a single ICD-10 code T86.100 or T86.101 was recorded as a hospital encounter discharge diagnosis.
Using chart review as the gold standard, we determined the sensitivity, specificity, and positive predictive value (PPV) for the ICD-10 codes T86.100 and T86.101.
Our study population comprised of 1,258 kidney transplant recipients. The prevalence of rejection and death-censored graft loss were 15.6 and 9.1%, respectively. For the ICD-10 rejection code (T86.100), sensitivity was 72.9% (95% confidence interval [CI], 66.6-79.2), specificity 97.5% (96.5-98.4), and PPV 83.8% (78.3-89.4). For the ICD-10 graft loss code (T86.101), sensitivity was 21.2% (95% CI, 13.2-29.3), specificity 86.3% (84.3-88.3), and PPV 11.7% (7.0-16.4).
Single-center study which may limit generalizability of our findings.
A single ICD-10 code for kidney transplant rejection (T86.100) was present in 84% of true kidney transplant rejections and is an accurate way of identifying kidney transplant recipients with rejection using administrative health data. The ICD-10 code for graft failure (T86.101) performed poorly and should not be used for administrative health research.
临床研究要求从常规收集的卫生行政数据中获取的诊断编码能够准确识别患有某种疾病的个体。
在本研究中，我们验证了国际疾病分类第十次修订版（ICD - 10）中肾移植排斥反应（T86.100）和肾移植失败（T86.101）的定义。
回顾性队列研究。
加拿大安大略省的一个大型区域移植中心。
2002年至2018年期间所有成年肾移植受者。
进行病历审查以确定所有参与者首次出现活检证实的排斥反应和移植物丢失的情况。对于每一次观察，我们确定首次将单个ICD - 10编码T86.100或T86.101记录为医院出院诊断的日期。
以病历审查作为金标准，我们确定了ICD - 10编码T86.100和T86.101的敏感性、特异性和阳性预测值（PPV）。
我们的研究人群包括1258名肾移植受者。排斥反应和死亡审查后的移植物丢失患病率分别为15.6%和9.1%。对于ICD - 10排斥反应编码（T86.100），敏感性为72.9%（95%置信区间[CI]，66.6 - 79.2），特异性为97.5%（96.5 - 98.4），PPV为83.8%（78.3 - 89.4）。对于ICD - 10移植物丢失编码（T86.101），敏感性为21.2%（95% CI，13.2 - 29.3），特异性为86.3%（84.3 - 88.3），PPV为11.7%（7.0 - 16.4）。
单中心研究，可能会限制我们研究结果的普遍性。
84%的真正肾移植排斥反应存在单个ICD - 10肾移植排斥反应编码（T86.100），这是使用卫生行政数据识别有排斥反应的肾移植受者的准确方法。ICD - 10移植物失败编码（T86.101）表现不佳，不应在卫生行政研究中使用。
