Validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in England: an observational study
Objectives Outcomes in hepatocellular carcinoma (HCC) are determined by both cancer characteristics and liver disease severity. This study aims to validate the use of inpatient electronic health records to determine liver disease severity from treatment and procedure codes.Design Retrospective obser...
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| Format: | Article |
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BMJ Publishing Group
2019-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/7/e028571.full |
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| author | Anya Burton Amy Downing Eva Morris Jessica Shearer Robert J Driver Vinay Balachandrakumar Tim Cross Ian A Rowe |
| author_facet | Anya Burton Amy Downing Eva Morris Jessica Shearer Robert J Driver Vinay Balachandrakumar Tim Cross Ian A Rowe |
| author_sort | Anya Burton |
| collection | DOAJ |
| description | Objectives Outcomes in hepatocellular carcinoma (HCC) are determined by both cancer characteristics and liver disease severity. This study aims to validate the use of inpatient electronic health records to determine liver disease severity from treatment and procedure codes.Design Retrospective observational study.Setting Two National Health Service (NHS) cancer centres in England.Participants 339 patients with a new diagnosis of HCC between 2007 and 2016.Main outcome Using inpatient electronic health records, we have developed an optimised algorithm to identify cirrhosis and determine liver disease severity in a population with HCC. The diagnostic accuracy of the algorithm was optimised using clinical records from one NHS Trust and it was externally validated using anonymised data from another centre.Results The optimised algorithm has a positive predictive value (PPV) of 99% for identifying cirrhosis in the derivation cohort, with a sensitivity of 86% (95% CI 82% to 90%) and a specificity of 98% (95% CI 96% to 100%). The sensitivity for detecting advanced stage cirrhosis is 80% (95% CI 75% to 87%) and specificity is 98% (95% CI 96% to 100%), with a PPV of 89%.Conclusions Our optimised algorithm, based on inpatient electronic health records, reliably identifies and stages cirrhosis in patients with HCC. This highlights the potential of routine health data in population studies to stratify patients with HCC according to liver disease severity. |
| format | Article |
| id | doaj-art-1404be526837463d987dbeeb6bd2f561 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-1404be526837463d987dbeeb6bd2f5612025-08-20T02:01:57ZengBMJ Publishing GroupBMJ Open2044-60552019-07-019710.1136/bmjopen-2018-028571Validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in England: an observational studyAnya Burton0Amy Downing1Eva Morris2Jessica Shearer3Robert J Driver4Vinay Balachandrakumar5Tim Cross6Ian A Rowe7National Cancer Registration and Analysis Service, Bristol, UKLeeds Institute of Medical Research, University of Leeds, Leeds, UKApplied Health Research Unit, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UKDepartment of Hepatology, Leeds Teaching Hospitals NHS Trust, Leeds, UKDepartment of Hepatology, Leeds Teaching Hospitals NHS Trust, Leeds, UKRoyal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UKRoyal Liverpool University Hospital, UK8 University of Leeds, Leeds, UKObjectives Outcomes in hepatocellular carcinoma (HCC) are determined by both cancer characteristics and liver disease severity. This study aims to validate the use of inpatient electronic health records to determine liver disease severity from treatment and procedure codes.Design Retrospective observational study.Setting Two National Health Service (NHS) cancer centres in England.Participants 339 patients with a new diagnosis of HCC between 2007 and 2016.Main outcome Using inpatient electronic health records, we have developed an optimised algorithm to identify cirrhosis and determine liver disease severity in a population with HCC. The diagnostic accuracy of the algorithm was optimised using clinical records from one NHS Trust and it was externally validated using anonymised data from another centre.Results The optimised algorithm has a positive predictive value (PPV) of 99% for identifying cirrhosis in the derivation cohort, with a sensitivity of 86% (95% CI 82% to 90%) and a specificity of 98% (95% CI 96% to 100%). The sensitivity for detecting advanced stage cirrhosis is 80% (95% CI 75% to 87%) and specificity is 98% (95% CI 96% to 100%), with a PPV of 89%.Conclusions Our optimised algorithm, based on inpatient electronic health records, reliably identifies and stages cirrhosis in patients with HCC. This highlights the potential of routine health data in population studies to stratify patients with HCC according to liver disease severity.https://bmjopen.bmj.com/content/9/7/e028571.full |
| spellingShingle | Anya Burton Amy Downing Eva Morris Jessica Shearer Robert J Driver Vinay Balachandrakumar Tim Cross Ian A Rowe Validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in England: an observational study BMJ Open |
| title | Validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in England: an observational study |
| title_full | Validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in England: an observational study |
| title_fullStr | Validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in England: an observational study |
| title_full_unstemmed | Validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in England: an observational study |
| title_short | Validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in England: an observational study |
| title_sort | validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in england an observational study |
| url | https://bmjopen.bmj.com/content/9/7/e028571.full |
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