Validation of three coding algorithms to identify patients with end-stage liver disease in an administrative database

D. Goldberg, J. D. Lewis, S. D. Halpern, Mark Weiner, Vincent Lo Re

Research output: Contribution to journalArticlepeer-review

96 Scopus citations


Purpose: Use of administrative or population-based databases for post-marketing pharmacoepidemiology research in patients with end-stage liver disease (ESLD) has been limited by the difficulty of accurately identifying such patients. Algorithms to identify patients with ESLD using ICD-9-CM codes have not been developed outside of the Veterans Affairs healthcare setting. Methods: We queried electronic medical records at two tertiary care hospitals to identify patients with ICD-9-CM codes indicative of ESLD. Coding algorithms were developed to identify patients with confirmed ESLD, and these were tested to determine their positive predictive value (PPV). Results: The presence of one inpatient or outpatient ICD-9-CM code for: (i) cirrhosis; (ii) chronic liver disease, and (iii) a hepatic decompensation event yielded a PPV of 85.2% (167/196; 95% CI: 79.4%-89.9%). The PPV increased to 89.3% (150/168; 95% CI: 83.6%-93.5%) when the algorithm required two or more ICD-9-CM codes for a hepatic decompensation. However, an algorithm requiring only one ICD-9-CM code for (i) cirrhosis and (ii) a hepatic decompensation event, in the absence of a chronic liver disease code, yielded a PPV of 85.7% (30/35; 95% CI: 69.7%-95.2%). Conclusions: A coding algorithm that includes at least one ICD-9-CM code for cirrhosis plus one ICD-9-CM code for a hepatic decompensation event has a high PPV for identifying patients with ESLD. The inclusion of at least two codes indicative of a hepatic decompensation event increased the PPV. This algorithm can be used in future epidemiologic studies to examine the outcomes of a variety of long-term medical therapies in patients with ESLD.

Original languageEnglish (US)
Pages (from-to)765-769
Number of pages5
JournalPharmacoepidemiology and Drug Safety
Issue number7
StatePublished - Jul 2012
Externally publishedYes


  • Cirrhosis
  • End-stage liver disease
  • Hepatic decompensation
  • ICD-9-CM code
  • Pharmacoepidemiology
  • Validation

ASJC Scopus subject areas

  • Epidemiology
  • Pharmacology (medical)


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