PDF(Pubmed)
Abstract：
BACKGROUND: Liver disorders are important adverse effects associated with antifungal drug treatment. However, the accuracy of Clinical International Classification of Diseases (ICD)-10 codes in identifying liver disorders for register based research is not well-established. This study aimed to determine the positive predictive value (PPV) of the ICD-10 codes for identifying patients with toxic liver disease, hepatic failure, and jaundice among patients with systemic antifungal treatment.
METHODS: Data from the Swedish Prescribed Drug Register and the National Patient Register were utilized to identify adult patients who received systemic azole antifungal drugs and had a recorded diagnosis of toxic liver disease (K71.0, K71.1, K71.2, K71.6, K71.8, K71.9), hepatic failure (K72.0, K72.9), or jaundice (R17) between 2005 and 2016. The medical records of all included patients were reviewed. Prespecified criteria were used to re-evaluate and confirm each diagnosis, serving as the gold standard to calculate PPVs with 95% confidence intervals (95% CI) for each diagnostic group.
RESULTS: Among the 115 included patients, 26 were diagnosed with toxic liver disease, 58 with hepatic failure, and 31 with jaundice. Toxic liver disease was confirmed in 14 out of 26 patients, yielding a PPV of 53.8% (95% CI 33.4-73.4%). Hepatic failure was confirmed in 26 out of 38 patients, resulting in a PPV of 62.1% (95% CI 48.4-74.5%). The highest PPV was found in jaundice, with 30 confirmed diagnoses out of 31, yielding a PPV of 96.8% (95% CI 83.3-99.9%).
CONCLUSIONS: Among patients who received azole antifungal treatment and were subsequently diagnosed with a liver disorder, the PPV for the diagnosis of jaundice was high, while the PPVs for toxic liver disease and hepatic failure were lower.
METHODS: Data from the Swedish Prescribed Drug Register and the National Patient Register were utilized to identify adult patients who received systemic azole antifungal drugs and had a recorded diagnosis of toxic liver disease (K71.0, K71.1, K71.2, K71.6, K71.8, K71.9), hepatic failure (K72.0, K72.9), or jaundice (R17) between 2005 and 2016. The medical records of all included patients were reviewed. Prespecified criteria were used to re-evaluate and confirm each diagnosis, serving as the gold standard to calculate PPVs with 95% confidence intervals (95% CI) for each diagnostic group.
RESULTS: Among the 115 included patients, 26 were diagnosed with toxic liver disease, 58 with hepatic failure, and 31 with jaundice. Toxic liver disease was confirmed in 14 out of 26 patients, yielding a PPV of 53.8% (95% CI 33.4-73.4%). Hepatic failure was confirmed in 26 out of 38 patients, resulting in a PPV of 62.1% (95% CI 48.4-74.5%). The highest PPV was found in jaundice, with 30 confirmed diagnoses out of 31, yielding a PPV of 96.8% (95% CI 83.3-99.9%).
CONCLUSIONS: Among patients who received azole antifungal treatment and were subsequently diagnosed with a liver disorder, the PPV for the diagnosis of jaundice was high, while the PPVs for toxic liver disease and hepatic failure were lower.
摘要：
背景：肝脏疾病是与抗真菌药物治疗相关的重要不良反应。然而,临床国际疾病分类(ICD)-10代码在识别基于注册研究的肝脏疾病方面的准确性尚未得到很好的证实.本研究旨在确定ICD-10代码的阳性预测值（PPV），用于识别中毒性肝病患者。肝衰竭,全身抗真菌治疗患者的黄疸。
方法：使用来自瑞典处方药物注册和国家患者注册的数据来识别接受全身性唑类抗真菌药物并已记录诊断为中毒性肝病的成年患者（K71.0，K71.1，K71.2，K71.6，K71.8，K71.9），肝功能衰竭（K72.0，K72.9），或黄疸（R17）在2005年至2016年之间。对所有纳入患者的医疗记录进行审查。使用预先指定的标准来重新评估和确认每个诊断，作为计算每个诊断组的95%置信区间(95%CI)的PPV的金标准。
结果：在纳入的115名患者中，26人被诊断患有中毒性肝病，58肝衰竭，31伴有黄疸.26例患者中有14例确诊为中毒性肝病，产生53.8%的PPV（95%CI33.4-73.4%）。38例患者中有26例确诊为肝功能衰竭，导致PPV为62.1%（95%CI48.4-74.5%）。在黄疸中发现了最高的PPV,31例确诊病例中有30例，PPV为96.8%（95%CI83.3-99.9%）。
结论：在接受唑类抗真菌治疗并随后被诊断患有肝脏疾病的患者中，诊断黄疸的PPV高,而中毒性肝病和肝衰竭的PPV较低。
方法：使用来自瑞典处方药物注册和国家患者注册的数据来识别接受全身性唑类抗真菌药物并已记录诊断为中毒性肝病的成年患者（K71.0，K71.1，K71.2，K71.6，K71.8，K71.9），肝功能衰竭（K72.0，K72.9），或黄疸（R17）在2005年至2016年之间。对所有纳入患者的医疗记录进行审查。使用预先指定的标准来重新评估和确认每个诊断，作为计算每个诊断组的95%置信区间(95%CI)的PPV的金标准。
结果：在纳入的115名患者中，26人被诊断患有中毒性肝病，58肝衰竭，31伴有黄疸.26例患者中有14例确诊为中毒性肝病，产生53.8%的PPV（95%CI33.4-73.4%）。38例患者中有26例确诊为肝功能衰竭，导致PPV为62.1%（95%CI48.4-74.5%）。在黄疸中发现了最高的PPV,31例确诊病例中有30例，PPV为96.8%（95%CI83.3-99.9%）。
结论：在接受唑类抗真菌治疗并随后被诊断患有肝脏疾病的患者中，诊断黄疸的PPV高,而中毒性肝病和肝衰竭的PPV较低。
