Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Department of Sociology, University of Calgary, Calgary, Alberta, Canada.
Hepatol Commun. 2024 Jun 19;8(7). doi: 10.1097/HC9.0000000000000469. eCollection 2024 Jul 1.
Alcohol (AC) and nonalcohol-associated cirrhosis (NAC) epidemiology studies are limited by available case definitions. We compared the diagnostic accuracy of previous and newly developed case definitions to identify AC and NAC hospitalizations.
We randomly selected 700 hospitalizations from the 2008 to 2022 Canadian Discharge Abstract Database with alcohol-associated and cirrhosis-related International Classification of Diseases 10th revision codes. We compared standard approaches for AC (ie, AC code alone and alcohol use disorder and nonspecific cirrhosis codes together) and NAC (ie, NAC codes alone) case identification to newly developed approaches that combine standard approaches with new code combinations. Using electronic medical record review as the reference standard, we calculated case definition positive and negative predictive values, sensitivity, specificity, and AUROC.
Electronic medical records were available for 671 admissions; 252 had confirmed AC and 195 NAC. Compared to previous AC definitions, the newly developed algorithm selecting for the AC code, alcohol-associated hepatic failure code, or alcohol use disorder code with a decompensated cirrhosis-related condition or NAC code provided the best overall positive predictive value (91%, 95% CI: 87-95), negative predictive value (89%, CI: 86-92), sensitivity (81%, CI: 76-86), specificity (96%, CI: 93-97), and AUROC (0.88, CI: 0.85-0.91). Comparing all evaluated NAC definitions, high sensitivity (92%, CI: 87-95), specificity (82%, CI: 79-86), negative predictive value (96%, CI: 94-98), AUROC (0.87, CI: 0.84-0.90), but relatively low positive predictive value (68%, CI: 62-74) were obtained by excluding alcohol use disorder codes and using either a NAC code in any diagnostic position or a primary diagnostic code for HCC, unspecified/chronic hepatic failure, esophageal varices without bleeding, or hepatorenal syndrome.
New case definitions show enhanced accuracy for identifying hospitalizations for AC and NAC compared to previously used approaches.
酒精性（AC）和非酒精性相关肝硬化（NAC）的流行病学研究受到现有病例定义的限制。我们比较了以前和新开发的病例定义的诊断准确性，以确定 AC 和 NAC 的住院治疗。
我们从 2008 年至 2022 年加拿大出院摘要数据库中随机选择了 700 例与酒精相关和肝硬化相关的国际疾病分类第 10 版代码的住院病例。我们比较了 AC 的标准方法（即仅 AC 代码和酒精使用障碍和非特异性肝硬化代码一起）和 NAC（即仅 NAC 代码）病例识别与新开发的方法，该方法将标准方法与新的代码组合相结合。使用电子病历审查作为参考标准，我们计算了病例定义的阳性和阴性预测值、敏感性、特异性和 AUROC。
共有 671 例住院患者的电子病历可用；252 例确诊为 AC，195 例为 NAC。与以前的 AC 定义相比，新开发的算法选择 AC 代码、酒精相关肝衰竭代码、或酒精使用障碍代码与失代偿性肝硬化相关疾病或 NAC 代码的方法提供了最佳的整体阳性预测值（91%，95%CI：87-95）、阴性预测值（89%，CI：86-92）、敏感性（81%，CI：76-86）、特异性（96%，CI：93-97）和 AUROC（0.88，CI：0.85-0.91）。比较所有评估的 NAC 定义，高敏感性（92%，CI：87-95）、特异性（82%，CI：79-86）、阴性预测值（96%，CI：94-98）、AUROC（0.87，CI：0.84-0.90），但阳性预测值相对较低（68%，CI：62-74），通过排除酒精使用障碍代码并使用任何诊断位置的 NAC 代码或原发性诊断代码 HCC、未指定/慢性肝衰竭、无出血性食管静脉曲张或肝肾综合征来实现。
与以前使用的方法相比，新的病例定义显示出在识别 AC 和 NAC 住院治疗方面具有更高的准确性。
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