Validity of an Automated Algorithm to Identify Cirrhosis Using Electronic Health Records in Patients with Primary Biliary Cholangitis

Figures & data

Table 1 Laboratory Data

Test	Collection Criteria/Additional Information
Serum alkaline phosphatase (ALP)	Four categories (normal, 1-<2 times ULN, 2-<3 times ULN, or ≥3 times ULN), as defined by the assay used at each FOLD site
Ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT)	Four categories (unknown; <1.1; 1.1-<2.2; ≥2.2) when tests were available within 7 days of one another
Albumin	Normal or abnormal, as defined by the assay used at each FOLD site
Total bilirubin	Seven categories (≤0.4, >0.4–0.5, >0.5–0.7, >0.7–1.0, >1.0–1.5, >1.5–2.0, >2.0 mg/dL)
AST to Platelet Ratio Index (APRI)	Numerical value, when tests were available within 7 days of one another
Fibrosis 4 Index (FIB4)	Numerical value, when tests were available within 7 days of one another
Platelet count	Numerical value

Table 2 ICD-9/10 and CPT Codes Comprising the Ten Cluster Variables (C1–C10)

Conditions	Associated ICD-9/10 and CPT Codes
C1: Liver transplant	V42.7, 996.82, 50.5, 50.51, 50.59, 47135, 47136, T86.40, T86.41, T86.42, 0FY00Z0,0FY00Z1, 0FY00Z2
C2: Liver cancer	155.0, 155.1, 155.2, C22.0, C22.2, C22.7, C22.8, C22.1, C22.9
C3: Hepatorenal syndrome	572.4, K76.7
C4: Hepatic encephalopathy	572.2, K72.09, K72.91
C5: Portal hypertension/portal decompression procedures	572.3, 37140, 37160, 37180, 37181, 37182, 37183, K76.6
C6: Esophageal varices complications (bleeding) and procedures	456.0, 456.20, 42.91, 44.91, 96.06, 43204, 43205, 43243, 43244, 43400, 43401, I85.01, I85.11, 06L30CZ, 06L30DZ, 06L30ZZ, 06L33CZ, 06L33DZ, 06L33ZZ, 06L34CZ, 06L34DZ, 06L34ZZ, 06L20ZZ, 06L23ZZ, 06L24ZZ, 0DL57DZ, 0DL58DZ
C7: Other gastrointestinal hemorrhage	530.7, 530.82, 578.0, 578.1, 578.9, K22.6, K22.8, K92.0, K92.1, K92.2
C8: Ascites/paracentesis procedures	789.5, 789.59, 54.91, 49080, 49081, 49082, 49083, R18.8, 0D9S30Z, 0D9S3ZZ, 0D9S40Z, 0D9S4ZZ, 0D9T30Z, 0D9T3ZZ, 0D9T40Z, 0D9T4ZZ, 0D9V30Z, 0D9V3ZZ, 0D9V40Z, 0D9V4ZZ, 0D9W30Z, 0D9W3ZZ, 0D9W40Z, 0D9W4ZZ, 0W9F30Z, 0W9F3ZZ, 0W9F40Z, 0W9F4ZZ, 0W9G30Z, 0W9G3ZZ, 0W9G40Z, 0W9G4ZZ, 0W9J30Z, 0W9J3ZZ
C9: Other sequelae of chronic liver disease	572.8, K72.10, K72.90
C10: Cirrhosis	571.2, 571.5, K70.30, K74.0, K74.60, K74.69

Table 3 Two-Group Comparison for Covariates of Interest

Variables*	Response**	F0–3	F4	p-value
		(N= 1229)	(N= 121)
Age in years		56.4 ± 11.6	58.7 ± 10.2	0.041
Gender	Women	1066 (87%)	99 (82%)	0.133
	Men	163 (13%)	22 (18%)
Race	Asian/ Native American/ Pacific Islander	98 (8%)	6 (5%)	0.054
	Black/ African American	109 (9%)	15 (12%)
	White	804 (65%)	88 (73%)
	Unknown	218 (18%)	12 (10%)
Hispanic ethnicity	Yes	366 (30%)	10 (8%)	<0.001
	No	780 (63%)	99 (82%)
	Unknown	83 (7%)	12 (10%)
Alkaline phosphatase (x ULN)	Normal	267 (22%)	28 (23%)	0.385
	[1, 2)*ULN	482 (39%)	40 (33%)
	[2, 3)*ULN	206 (17%)	28 (23%)
	≥3*ULN	259 (21%)	23 (19%)
	Unknown	15 (1%)	2 (2%)
Alanine aminotransferase (x ULN)	Normal	561 (46%)	38 (31%)	0.013
	[1, 2)*ULN	370 (30%)	45 (37%)
	[2, 3)*ULN	149 (12%)	14 (12%)
	≥3*ULN	146 (12%)	24 (20%)
	Unknown	3 (0%)	0 (0%)
Aspartate aminotransferase (x ULN)	Normal	429 (35%)	22 (18%)	<0.001
	[1, 2)*ULN	401 (33%)	33 (27%)
	[2, 3)*ULN	162 (13%)	23 (19%)
	≥3*ULN	184 (15%)	42 (35%)
	Unknown	53 (4%)	1 (1%)
Platelet count (x LLN)	Normal	923 (75%)	68 (56%)	<0.001
	(0.5, 1.0)*LLN	99 (8%)	34 (28%)
	(0.33, 0.5]*LLN	11 (1%)	6 (5%)
	(0, 0.33]*LLN	143 (12%)	11 (9%)
	Unknown	53 (4%)	2 (2%)
AST/ALT Ratio	<1.1	839 (68%)	36 (30%)	<0.001
	1.1>2.2	287 (23%)	68 (56%)
	≥2.2	37 (3%)	16 (13%)
	Unknown	66 (5%)	1 (1%)
Total Bilirubin (IU/L)	(0, 0.4)	324 (26%)	10 (8%)	<0.001
	(0.4, 0.5)	139 (11%)	7 (6%)
	(0.5, 0.7)	204 (17%)	17 (14%)
	(0.7, 1.0)	208 (17%)	16 (13%)
	(1.0, 1.5)	118 (10%)	17 (14%)
	(1.5, 2.0)	39 (3%)	12 (10%)
	>2.0	99 (8%)	41 (34%)
	Unknown	98 (8%)	1 (1%)
Albumin (xLLN)	<LLN	268 (22%)	51 (42%)	<0.001
	Normal	720 (59%)	40 (33%)
	Unknown	241 (20%)	30 (25%)
C1	No	1199 (98%)	97 (80%)	<0.001
	Yes	30 (2%)	24 (20%)
C2	No	1211 (99%)	119 (98%)	0.87
	Yes	18 (1%)	2 (2%)
C3	No	1222 (99%)	116 (96%)	<0.001
	Yes	7 (1%)	5 (4%)
C4	No	1206 (98%)	108 (89%)	<0.001
	Yes	23 (2%)	13 (11%)
C5	No	1180 (96%)	100 (83%)	<0.001
	Yes	49 (4%)	21 (17%)
C6	No	1211 (99%)	112 (93%)	<0.001
	Yes	18 (1%)	9 (7%)
C7	No	1182 (96%)	109 (90%)	0.002
	Yes	47 (4%)	12 (10%)
C8	No	1162 (95%)	88 (73%)	<0.001
	Yes	67 (5%)	33 (27%)
C9	No	1193 (97%)	100 (83%)	<0.001
	Yes	36 (3%)	21 (17%)
C10 (≥2 records)	No	1066 (87%)	53 (44%)	<0.001
	Yes	163 (13%)	68 (56%)
APRI		2.0 ± 4.6	4.6 ± 12.6	0.033
Aspartate aminotransferase (mean ±SD)		82.7 ± 180.3	220.0 ± 423.8	<0.001
Alkaline phosphatase (mean ±SD)		278.6 ± 232.6	304.7 ± 359.0	0.438
Platelet count (mean ±SD)		211.6 ± 111.6	158.4 ± 80.0	<0.001
AST/ALT Ratio (mean ±SD)		1.1 ± 1.0	1.4 ± 0.7	<0.001
Fibrosis-4 Index (mean ± SD)		10.8 ± 33.9	12.4 ± 29.6	0.634

Notes: *all data were collected within six months of the biopsy assessment. **determined based on the highest fibrosis stage biopsy results if multiple assessments were involved.