Skip to main content
SpringerLink
Log in

Positive Predictive Value of Cirrhosis and Chronic Pancreatitis Diagnoses in Individuals with Alcohol Use Disorder: A Single-Center Study

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Although accuracy of diagnosis codes for cirrhosis and chronic pancreatitis (CP) has been evaluated in multiple studies, none have focused on patients with alcohol use disorders (AUD). We evaluated the positive predictive value (PPV) for a verified diagnosis of cirrhosis and CP in AUD patients treated at a tertiary care center.

Methods

We performed a detailed review of electronic health records for AUD patients assigned ICD-9 or 10 codes for alcoholic cirrhosis (ALC) (n = 199), CP (n = 200), or both (n = 200). We calculated PPV for a verified diagnosis of cirrhosis and CP and performed multivariable regression analysis to assess the impact of relevant factors on PPV for a verified diagnosis.

Results

PPV of cirrhosis was 81.2% (95% CI 77.0 to 84.9%) which increased to 87.5% (95% CI 83.8 to 90.6%) if the definition was relaxed to include alcohol-related hepatitis. PPV of CP was 54.5% (95% CI 49.5 to 59.5%) which increased to 78% (95% CI 73.6 to 82.0%) when recurrent acute pancreatitis was included in the definition. In multivariable analyses, the odds of a verified diagnosis were significantly higher in individuals aged 65+ years for both cirrhosis (OR 12.23, 95% CI 2.19 to 68.42) and CP (OR 8.84, 95% CI 2.7 to 28.93) and in ever smokers for CP (OR 1.95, 95% CI 1.05 to 3.65).

Conclusion

PPV for diagnosis codes in AUD patients is high for a verified diagnosis of cirrhosis but only modest for CP. While administrative datasets can provide reliable information for cirrhosis, future studies should focus on ways to boost the diagnostic validity of administrative datasets for CP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Roerecke M, Vafaei A, Hasan OSM et al. Alcohol Consumption and Risk of Liver Cirrhosis: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2019;114:1574–1586.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Samokhvalov AV, Rehm J, Roerecke M. Alcohol Consumption as a Risk Factor for Acute and Chronic Pancreatitis: A Systematic Review and a Series of Meta-analyses. EBioMedicine 2015;2:1996–2002.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Seitz HK, Bataller R, Cortez-Pinto H et al. Alcoholic liver disease. Nat Rev Dis Primers 2018;4:16.

    Article  PubMed  Google Scholar 

  4. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013;144:1252–1261.

    Article  PubMed  Google Scholar 

  5. Global status report on alcohol and health 2018. World Health Organization, Geneva, 2018:75.

  6. O’Malley KJ, Cook KF, Price MD, Wildes KR, Hurdle JF, Ashton CM. Measuring diagnoses: ICD code accuracy. Health Serv Res 2005;40:1620–1639.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dahiya M, Eboreime E, Hyde A et al. International Classification of Diseases Codes are Useful in Identifying Cirrhosis in Administrative Databases. Dig Dis Sci 2022;67:2107–2122.

    Article  PubMed  Google Scholar 

  8. Burkholder DA, Moran IJ, DiBattista JV, Lok AS, Parikh ND, Chen VL. Accuracy of International Classification of Diseases-10 Codes for Cirrhosis and Portal Hypertensive Complications. Dig Dis Sci 2022;67:3623–3632.

    Article  PubMed  Google Scholar 

  9. Xiao AY, Tan ML, Plana MN, Yadav D, Zamora J, Petrov MS. The Use of International Classification of Diseases Codes to Identify Patients with Pancreatitis: A Systematic Review and Meta-analysis of Diagnostic Accuracy Studies. Clin Transl Gastroenterol 2018;9:191.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Banks PA, Bollen TL, Dervenis C et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102–111.

    Article  PubMed  Google Scholar 

  11. Whitcomb DC, Shimosegawa T, Chari ST et al. International consensus statements on early chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with The International Association of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest Working Group and European Pancreatic Club. Pancreatology 2018;18:516–527.

    Article  PubMed  Google Scholar 

  12. Vanga RR, Tansel A, Sidiq S, El-Serag HB, Othman MO. Diagnostic Performance of Measurement of Fecal Elastase-1 in Detection of Exocrine Pancreatic Insufficiency: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2018;16:1220–1228.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Conwell DL, Lee LS, Yadav D et al. American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: evidence-based report on diagnostic guidelines. Pancreas 2014;43:1143–1162.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Stevens T, Lopez R, Adler DG et al. Multicenter comparison of the interobserver agreement of standard EUS scoring and Rosemont classification scoring for diagnosis of chronic pancreatitis. Gastrointest Endosc 2010;71:519–526.

    Article  PubMed  Google Scholar 

  15. Mel Wilcox C, Gress T, Boermeester M et al. International consensus guidelines on the role of diagnostic endoscopic ultrasound in the management of chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club. Pancreatology 2020;20:822–827.

    Article  CAS  PubMed  Google Scholar 

  16. Sheel ARG, Baron RD, Sarantitis I et al. The diagnostic value of Rosemont and Japanese diagnostic criteria for “indeterminate”, “suggestive”, “possible” and “early” chronic pancreatitis. Pancreatology 2018;18:774–784.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank the Enhancing MEntoring to Improve Research in GastroEnterology (EMERGE) Program of the Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh for supporting this project.

Funding

None.

Author information

Author notes

  1. Yujie Sun and Michael Lu have contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Yujie Sun, Michael Lu & Melissa Saul

  2. Center for Research on Health Care Data Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Robert Feldman & Andrew Althouse

  3. Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop Street, M2, C-wing, Pittsburgh, PA, 15213, USA

    Gavin Arteel & Dhiraj Yadav

Authors
  1. Yujie Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Feldman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Melissa Saul
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew Althouse
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gavin Arteel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dhiraj Yadav
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DY designed the research, contributed to the analysis, and wrote the paper; ML and YS performed the research, contributed to the analysis, and wrote the paper; GA contributed to the design of the study and provided clinical advice; MS retrieved patient information from UPMC databases and RF and AA performed the research and statistical analysis. YS and ML did chart review and DY was senior author. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Dhiraj Yadav.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was reviewed and approved by the Institutional Review Board of the University of Pittsburgh (STUDY 20100015).

Informed consent

We obtained a waiver of informed consent since the research represents no more than minimal risk of harm to subjects and involves no procedures for which written consent is normally required outside of the research context.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 19 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sun, Y., Lu, M., Feldman, R. et al. Positive Predictive Value of Cirrhosis and Chronic Pancreatitis Diagnoses in Individuals with Alcohol Use Disorder: A Single-Center Study. Dig Dis Sci 69, 596–602 (2024). https://doi.org/10.1007/s10620-023-08183-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-023-08183-x

Keywords

Search

Navigation