Algorithms to Identify Alcoholic Hepatitis Hospitalizations in Patients with Cirrhosis.
Algorithms to Identify Alcoholic Hepatitis Hospitalizations in Patients with Cirrhosis.
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DOI：
10.1007/s10620-021-07321-7
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发表时间：
2022-09
影响因子：
3.1
通讯作者：
Mahmud, Nadim
中科院分区：
文献类型：
--
作者：
Panchal, Sarjukumar A.;Kaplan, David E.;Goldberg, David S.;Mahmud, Nadim
酒精性肝炎（AH）是一种临床诊断的综合征，短期死亡率高，肝移植可能是治愈的。缺乏有效的算法来识别AH住院阻碍了临床流行病学研究。这是一项使用退伍军人健康管理局（VHA）2008年至2015年数据的肝硬化患者回顾性队列研究。我们根据肝功能检查异常和急性肝炎或酒精相关性肝病（ALD）的行政代码随机抽样住院。根据社会指南手动裁定AH住院。评估先验算法以计算阳性预测值（PPV）和阳性似然比（LR+），并在宾夕法尼亚大学卫生系统（UPHS）队列的外部进行测试。在368例住院治疗中，142例（38.6%）被裁定为AH。AH患者更年轻（55 vs. 58岁，p < 0.001），既往肝硬化失代偿的可能性更小（57% vs. 73.9%，p < 0.001），AST/ALT比值更高（中位数2.9 vs. 1.9 mg/dL，p < 0.001），胆红素水平更高（中位数2.9 vs. 1.9 mg/dL，p < 0.001）。结合临床实验室标准（AST > 85 U/L但< 450 U/L，AST/ALT比值> 2，总胆红素> 5 mg/dL）和管理编码标准的算法产生最高PPV（96.4%，95% CI 87.7-99.6）和最高LR+（43.0，95% CI 10.6-173.5）。几种算法证明UPHS外部队列中明确AH的PPV为100%。我们已经确定了具有出色PPV和LR+的AH住院治疗算法。这些高特异性算法可用于VHA数据集，以识别AH可能性高的患者，但不应用于研究AH发生率。
Alcoholic hepatitis (AH) is a clinically diagnosed syndrome with high short-term mortality for which liver transplantation may be curative. A lack of validated algorithms to identify AH hospitalizations has hindered clinical epidemiology research. This was a retrospective cohort study of patients with cirrhosis using Veterans Health Administration (VHA) data from 2008 to 2015. We randomly sampled hospitalizations based upon abnormal liver tests and administrative codes for acute hepatitis or alcohol-associated liver disease (ALD). Hospitalizations were manually adjudicated for AH per society guidelines. A priori algorithms were evaluated to compute positive predicted value (PPV) and positive likelihood ratio (LR+), and were tested in an external University of Pennsylvania Health System (UPHS) cohort. Of 368 hospitalizations, 142 (38.6%) were adjudicated as AH. AH patients were younger (55 vs. 58 years, p < 0.001), less likely to have prior cirrhosis decompensation (57% vs. 73.9%, p < 0.001), and had higher AST-to-ALT ratios (median 2.9 vs. 1.9 mg/dL, p < 0.001) and higher bilirubin levels (median 2.9 vs. 1.9 mg/dL, p < 0.001). Algorithms combining clinical laboratory criteria (AST > 85 U/L but < 450 U/L, AST-to-ALT ratio > 2, total bilirubin > 5 mg/dL) and administrative coding criteria yielded the highest PPV (96.4%, 95% CI 87.7–99.6) and the highest LR+ (43.0, 95% CI 10.6–173.5). Several algorithms demonstrated 100% PPV for definite AH in the UPHS external cohort. We have identified algorithms for AH hospitalizations with excellent PPV and LR+. These high-specificity algorithms may be used in VHA datasets to identify patients with high likelihood of AH, but should not be used to study AH incidence.
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DOI：
10.1016/j.cgh.2017.11.045
发表时间：
2018-08
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Cholankeril G;Ahmed A
通讯作者：
Ahmed A
DOI：
10.1002/hep.31558
发表时间：
2021-01
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Mahmud N;Fricker Z;Hubbard RA;Ioannou GN;Lewis JD;Taddei TH;Rothstein KD;Serper M;Goldberg DS;Kaplan DE
通讯作者：
Kaplan DE
2001-2013 年美国退伍军人肝硬化和肝细胞癌负担趋势（按肝脏疾病分类
影响因子：
29.4
作者：
Beste, Lauren A.;Leipertz, Steven L.;Ioannou, George N.
通讯作者：
Ioannou, George N.
影响因子：
2.9
作者：
Jinjuvadia R;Liangpunsakul S;Translational Research and Evolving Alcoholic Hepatitis Treatment Consortium
通讯作者：
Translational Research and Evolving Alcoholic Hepatitis Treatment Consortium
DOI：
10.1016/j.cgh.2015.07.010
发表时间：
2015-12
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Kaplan DE;Dai F;Aytaman A;Baytarian M;Fox R;Hunt K;Knott A;Pedrosa M;Pocha C;Mehta R;Duggal M;Skanderson M;Valderrama A;Taddei TH;VOCAL Study Group
通讯作者：
VOCAL Study Group