Seasonality in acute liver injury? Findings in two health care claims databases

Figures & data

Figure 1 Prevalence of ALI.

Notes: Prevalence in (A) CCAE database and (B) MDCR database. Data presented as mean and 95% CI.
Abbreviations: ALI, acute liver injury; CCAE, Truven MarketScan^® Commercial Claims and Encounters database; CI, confidence interval; MDCR, Truven MarketScan^® Medicare Supplemental and Coordination of Benefits database.

Figure 2 Prevalence of negative- and positive-control events.

Notes: Prevalence in (A) CCAE database and (B) MDCR database. Common cold and influenza are positive controls. Data presented as mean and 95% CI.
Abbreviations: CCAE, Truven MarketScan^® Commercial Claims and Encounters database; CI, confidence interval; MDCR, Truven MarketScan^® Medicare Supplemental and Coordination of Benefits database.

Table 1 Results of the tests for seasonality using CCAE data

	β3	P (β3)	R	P (R)
ALI	−0.01	0.04	1.03	0.84
ALI, no comorbidities	−0.02	0.00	1.02	0.91
ALI, both comorbidities	−0.01	0.36	1.16	0.51
ALI, either comorbidity	0.00	0.84	1.06	0.76
ALI, narrow definitiona	0.00	0.80	1.07	0.81
ALI, narrow definitiona and no comorbidities	−0.04	0.07	1.10	0.80
ALI, narrow definitiona and both comorbidities	0.01	0.59	1.32	0.48
ALI, narrow definitiona and either comorbidity	0.02	0.18	1.11	0.75
ALI, broad definitionb	0.01	0.00	1.07	0.23
Breast cancer	0.01	0.00	1.05	0.26
Common cold	0.05	0.00	2.59	0.00
Diabetes mellitus	0.04	0.00	1.07	0.01
Influenza	0.25	0.00	6.55	0.00

Notes: β₃ indicates the coefficient attributed to the linear time component for capturing long-term trends. P (β₃) is the P-value corresponding to the null hypothesis that P (β₃)=0. R is the ratio of peak-to-low occurrence rates, and P(R) is the P-value corresponding to the null hypothesis that R=1.

a The occurrence of any ALI diagnosis code as the primary diagnosis for hospitalization and either one of the ALI diagnostic codes in the 30 days preceding or including the day of hospitalization, or one of the ALI therapeutic procedure codes in the 30 days following or including the day of hospitalization.

b The occurrence of any ALI diagnosis code without requiring hospitalization (emergency department or outpatient visit).

Abbreviations: ALI, acute liver injury; CCAE, Truven MarketScan^® Commercial Claims and Encounters database.

Table 2 Results of the tests for seasonality using MDCR data

	β3	P (β3)	R	P (R)
ALI	0.00	0.87	1.01	0.97
ALI, no comorbidities	−0.01	0.36	1.04	0.88
ALI, both comorbidities	0.01	0.71	1.09	0.79
ALI, either comorbidity	0.01	0.28	1.02	0.93
ALI, narrow definitiona	−0.03	0.34	1.17	0.72
ALI, narrow definitiona and no comorbidities	−0.04	0.40	1.38	0.53
ALI, narrow definitiona and both comorbidities	−0.03	0.81	1.41	0.67
ALI, narrow definitiona and either comorbidity	−0.02	0.65	1.22	0.70
ALI, broad definitionb	0.06	0.00	1.04	0.61
Breast cancer	0.04	0.00	1.02	0.65
Common cold	0.07	0.00	2.76	0.00
Diabetes mellitus	0.07	0.00	1.03	0.34
Influenza	0.01	0.00	6.13	0.00

Notes: β₃ indicates the coefficient attributed to the linear time component for capturing long-term trends. P (β₃) is the P-value corresponding to the null hypothesis that P (β₃)=0. R is the ratio of peak-to-low occurrence rates, and P(R) is the P-value corresponding to the null hypothesis that R=1.

a The occurrence of any ALI diagnosis code as the primary diagnosis for hospitalization and either one of the ALI diagnostic codes in the 30 days preceding or including the day of hospitalization, or one of the ALI therapeutic procedure codes in the 30 days following or including the day of hospitalization.

b The occurrence of any ALI diagnosis code without requiring hospitalization (emergency department or outpatient visit).

Abbreviations: ALI, acute liver injury; MDCR, Truven MarketScan^® Medicare Supplemental and Coordination of Benefits database.

Table S1 ICD-9-CM diagnosis, CPT-4, and ICD-9-Procedure codes for acute liver injury

ICD-9-CM	570	Acute and subacute necrosis of liver
ICD-9-CM	572.2	Hepatic coma
ICD-9-CM	572.4	Hepatorenal syndrome
ICD-9-CM	573	Chronic passive congestion of liver
ICD-9-CM	573.1	Hepatitis in viral diseases classified elsewhere
ICD-9-CM	573.2	Hepatitis in other infectious diseases classified elsewhere
ICD-9-CM	573.3	Hepatitis, unspecified
ICD-9-CM	573.4	Hepatic infarction
ICD-9-CM	573.8	Other specified disorders of liver
ICD-9-CM	573.9	Unspecified disorder of liver
CPT-4	47000	Biopsy of liver, needle; percutaneous
CPT-4	47001	Biopsy of liver, needle; when done for indicated purpose at time of other major procedure (list separately in addition to code for primary procedure)
CPT-4	47100	Biopsy of liver, wedge
CPT-4	78205	Liver imaging (SPECT)
CPT-4	78206	Liver imaging (SPECT), with vascular flow
ICD-9-Procedure	50.11	Closed (percutaneous) needle biopsy of liver
ICD-9-Procedure	50.12	Open biopsy of liver
ICD-9-Procedure	50.13	Transjugular liver biopsy
ICD-9-Procedure	50.14	Laparoscopic liver biopsy
ICD-9-Procedure	50.91	Percutaneous aspiration of liver
CPT-4	47135	Liver allotransplantation; orthotopic, partial or whole, from cadaver or living donor, any age
CPT-4	47136	Liver allotransplantation; heterotopic, partial or whole, from cadaver or living donor, any age
ICD-9-Procedure	50.5	Liver transplant
ICD-9-Procedure	50.51	Auxiliary liver transplant
ICD-9-Procedure	50.59	Other transplant of liver

Abbreviations: CPT, Current Procedural Terminology; ICD-9-Procedure, International Classification of Diseases, Ninth Revision, Procedure; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; SPECT, single-photon emission computed tomography.

Table S2 ICD-9-CM diagnosis codes for comorbidities

Cirrhosis
571	Alcoholic fatty liver
571	Chronic liver disease and cirrhosis
571.2	Alcoholic cirrhosis of liver
571.3	Alcoholic liver damage, unspecified
571.5	Cirrhosis of liver without mention of alcohol
571.6	Biliary cirrhosis
Hepatitis
70	Viral hepatitis A with hepatic coma
70.1	Viral hepatitis A without mention of hepatic coma
70.2	Viral hepatitis B with hepatic coma
70.2	Viral hepatitis B with hepatic coma, acute or unspecified, without mention of hepatitis delta
70.21	Viral hepatitis B with hepatic coma, acute or unspecified, with hepatitis delta
70.22	Viral hepatitis B with hepatic coma, chronic, without mention of hepatitis delta
70.23	Viral hepatitis B with hepatic coma, chronic, with hepatitis delta
70.3	Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta
70.31	Viral hepatitis B without mention of hepatic coma, acute or unspecified, with hepatitis delta
70.32	Viral hepatitis B without mention of hepatic coma, chronic, without mention of hepatitis delta
70.33	Viral hepatitis B without mention of hepatic coma, chronic, with hepatitis delta
70.4	Other specified viral hepatitis with hepatic coma
70.41	Acute hepatitis C with hepatic coma
70.42	Hepatitis delta without mention of active hepatitis B disease with hepatic coma
70.43	Hepatitis E with hepatic coma
70.44	Chronic hepatitis C with hepatic coma
70.49	Other specified viral hepatitis with hepatic coma
70.5	Other specified viral hepatitis without mention of hepatic coma
70.51	Acute hepatitis C without mention of hepatic coma
70.52	Hepatitis delta without mention of active hepatitis B disease or hepatic coma
70.53	Hepatitis E without mention of hepatic coma
70.54	Chronic hepatitis C without mention of hepatic coma
70.59	Other specified viral hepatitis without mention of hepatic coma
70.6	Unspecified viral hepatitis with hepatic coma
70.7	Unspecified viral hepatitis C
70.7	Unspecified viral hepatitis C without hepatic coma
70.71	Unspecified viral hepatitis C with hepatic coma
70.9	Unspecified viral hepatitis without mention of hepatic coma
571.1	Acute alcoholic hepatitis
571.4	Chronic hepatitis, unspecified
571.41	Chronic persistent hepatitis
571.49	Other chronic hepatitis
571.8	Other chronic nonalcoholic liver disease
571.9	Unspecified chronic liver disease without mention of alcohol
573	Chronic passive congestion of liver
573.1	Hepatitis in viral diseases classified elsewhere
573.2	Hepatitis in other infectious diseases classified elsewhere
573.3	Hepatitis, unspecified
573.4	Hepatic infarction
573.8	Other specified disorders of liver
573.9	Unspecified disorder of liver

Abbreviation: ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification.