Division of Gastroenterology and Hepatology, Miami VA Medical System, and Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA.
Pharmacoepidemiol Drug Saf. 2024 Oct;33(10):e70013. doi: 10.1002/pds.70013.
The accuracy of administrative codes to capture patients with both primary biliary cholangitis (PBC) and cirrhosis could be challenging because of the potential for incorrect coding due to the old nomenclature "Primary Biliary Cirrhosis." Therefore, the aim of this study was to examine the positive predictive value (PPV) of International Classification of Diseases (ICD) codes for PBC and cirrhosis.
This was a retrospective cohort study using data from the VA Corporate Data Warehouse. Eligibility criteria included adult patients diagnosed to have PBC and cirrhosis based on one inpatient or two outpatient ICD 9 or 10 codes, and were validated against chart review of each participant.
We identified 1408 patients who were found to have ICD codes for both cirrhosis and PBC. The ICD 9/10 codes for PBC and cirrhosis had a PPV of 0.75 (95% CI 0.73-0.75) for cirrhosis, 0.75 for PBC (95% CI 0.73-0.78), and 0.52 (0.50-0.55) for PBC and cirrhosis. When portal hypertension was combined with ICD 9/10 codes, the PPV of cirrhosis improved to 0.92 (0.90-0.94), and that of PBC cirrhosis improved to 0.64 (0.60-0.67). By combining ICD 9/10 codes for portal hypertension and receipt of ursodeoxycholic acid (UDCA), the PPV for cirrhosis improved to 0.91 (0.88-0.94), PBC increased to 0.78 (0.74-0.82), and that for PBC cirrhosis to 0.69 (0.65-0.74).
In a large national cohort, the use of ICD 9/10 codes had modest reliability for identifying participants with PBC and cirrhosis. The PPV for cirrhosis can be improved by incorporating ICD 9/10 codes for portal hypertension with receipt of UDCA.
由于旧的命名法“原发性胆汁性肝硬化”可能导致编码错误，因此行政代码捕捉原发性胆汁性胆管炎（PBC）和肝硬化患者的准确性可能具有挑战性。因此，本研究旨在检查国际疾病分类（ICD）代码用于 PBC 和肝硬化的阳性预测值（PPV）。
这是一项使用退伍军人事务部公司数据仓库数据的回顾性队列研究。纳入标准包括根据一个住院或两个门诊 ICD 9 或 10 代码诊断为患有 PBC 和肝硬化的成年患者，并通过对每位参与者的图表审查进行验证。
我们确定了 1408 名患者，他们的 ICD 代码同时存在肝硬化和 PBC。ICD 9/10 代码用于肝硬化和 PBC 的肝硬化的 PPV 为 0.75（95%CI 0.73-0.75），PBC 为 0.75（95%CI 0.73-0.78），PBC 和肝硬化为 0.52（0.50-0.55）。当门静脉高压与 ICD 9/10 代码相结合时，肝硬化的 PPV 提高到 0.92（0.90-0.94），PBC 肝硬化的 PPV 提高到 0.64（0.60-0.67）。通过结合 ICD 9/10 代码门静脉高压和熊去氧胆酸（UDCA）的使用，肝硬化的 PPV 提高到 0.91（0.88-0.94），PBC 增加到 0.78（0.74-0.82），PBC 肝硬化提高到 0.69（0.65-0.74）。
在一个大型的全国队列中，ICD 9/10 代码用于识别 PBC 和肝硬化患者的可靠性适中。通过将 ICD 9/10 代码门静脉高压与 UDCA 的使用相结合，可以提高肝硬化的 PPV。
