背景:酒精(AC)和非酒精相关性肝硬化(NAC)流行病学研究受到可用病例定义的限制。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住院。
方法: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名住院患者,其中包含酒精相关和肝硬化相关的国际疾病分类第10次修订代码。我们比较了AC的标准方法(即,单独的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)将标准方法与新代码组合相结合的新开发方法的案例识别。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,灵敏度,特异性,AUROC。
结果:671例入院患者有电子病历;252例确诊为AC,195例确诊为NAC。与以前的AC定义相比,新开发的AC码选择算法,酒精相关的肝衰竭代码,或患有失代偿性肝硬化相关疾病的酒精使用障碍代码或NAC代码提供了最佳的总体阳性预测值(91%,95%CI:87-95),阴性预测值(89%,CI:86-92),灵敏度(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,高灵敏度(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在任何诊断位置使用NAC代码或HCC的主要诊断代码来获得,未指明/慢性肝衰竭,食管静脉曲张无出血,或者肝肾综合征.
结论:与以前使用的方法相比,新的病例定义在确定AC和NAC住院方面的准确性提高。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: New case definitions show enhanced accuracy for identifying hospitalizations for AC and NAC compared to previously used approaches.