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
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
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DOI：
10.1136/bmjopen-2018-028571
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发表时间：
2019-08-01
期刊：
影响因子：
2.9
通讯作者：
Rowe, Ian A.
中科院分区：
文献类型：
--
作者：
Driver, Robert J.;Balachandrakumar, Vinay;Rowe, Ian A.
目的肝细胞癌（HCC）的预后取决于肿瘤特征和肝脏疾病的严重程度。本研究旨在验证使用住院患者电子健康记录来确定治疗和程序代码中的肝病严重程度。设计回顾性观察性研究。设置英格兰的两个国家卫生服务（NHS）癌症中心。参与者339例2007年至2016年期间新诊断为HCC的患者。主要结果使用住院患者电子健康记录，我们已经开发了一种优化的算法来识别肝硬化并确定HCC人群中肝脏疾病的严重程度。该算法的诊断准确性进行了优化，从一个NHS信托的临床记录，它是外部验证使用匿名数据从另一个center.Results优化的算法有一个阳性预测值（PPV）为99%，用于识别肝硬化的衍生队列，敏感性为86%（95%CI 82%至90%），特异性为98%（95%CI 96%至100%）。检测晚期肝硬化的敏感性为80%（95%CI 75%~ 87%），特异性为98%（95%CI 96%~ 100%），PPV为89%.Conclusions我们的优化算法，基于住院患者电子健康记录，可靠地识别和分期肝硬化HCC患者。这突出了人群研究中常规健康数据根据肝病严重程度对HCC患者进行分层的潜力。
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.