Detecting non-alcoholic fatty liver disease and risk factors in health databases: accuracy and limitations of the ICD-10-AMKelly Lee Hayward et al. BMJ Open Gastroenterol. 2021 Feb. Show
Free PMC article AbstractObjective: The prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) cirrhosis is often underestimated in healthcare and administrative databases that define disease burden using International Classification of Diseases (ICD) codes. This retrospective audit was conducted to explore the accuracy and limitations of the ICD, Tenth Revision, Australian Modification (ICD-10-AM) to detect NAFLD, metabolic risk factors (obesity and diabetes) and other aetiologies of chronic liver disease. Design/method: ICD-10-AM codes in 308 admitted patient encounters at two major Australian tertiary hospitals were compared with data abstracted from patients' electronic medical records. Accuracy of individual codes and grouped combinations was determined by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Cohen's kappa coefficient (κ). Results: The presence of an ICD-10-AM code accurately predicted the presence of NAFLD/NASH (PPV 91.2%) and obesity (PPV 91.6%) in most instances. However, codes underestimated the prevalence of NAFLD/NASH and obesity by 42.9% and 45.3%, respectively. Overall concordance between clinical documentation and 'grouped alcohol' codes (κ 0.75) and hepatitis C codes (κ 0.88) was high. Hepatitis B codes detected false-positive cases in patients with previous exposure (PPV 55.6%). Accuracy of codes to detect diabetes was excellent (sensitivity 95.8%; specificity 97.6%; PPV 94.9%; NPV 98.1%) with almost perfect concordance between codes and documentation in medical records (κ 0.93). Conclusion: Recognition of the utility and limitations of ICD-10-AM codes to study the burden of NAFLD/NASH cirrhosis is imperative to inform public health strategies and appropriate investment of resources to manage this burgeoning chronic disease. Keywords: cirrhosis; diabetes mellitus; epidemiology; nonalcoholic steatohepatitis; obesity. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Conflict of interest statementCompeting interests: None declared. Figures
 Heatmap depicting prevalence and clustering of CLD aetiologies and cirrhosis according to clinical review in 126 encounters that contained code K74.6 ‘Other and unspecified cirrhosis of liver’. Columns represent individual encounters. ALD, alcohol-related liver disease; CLD, chronic liver disease; HBV, hepatitis B virus; HCV, hepatitis C virus; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis. Prevalence and clustering of ICD-10-AM codes in 91 encounters among patients with NAFLD/NASH on clinical review (A) and 47 encounters among patients with NAFLD/NASH without a concurrent aetiology of CLD on clinical review (B). Columns represent individual encounters. *Refer to table 1 for ‘grouped alcohol’ codes. CLD, chronic liver disease; HCV, hepatitis C virus; ICD-10-AM, International Classification of Diseases, Tenth Revision, Australian Modification; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; T2DM, type 2 diabetes mellitus. Similar articles
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What is cirrhosis due to NASH?The main complication of NAFLD and NASH is cirrhosis, which is late-stage scarring in the liver. Cirrhosis occurs in response to liver injury, such as the inflammation in NASH . As the liver tries to halt inflammation, it produces areas of scarring (fibrosis).
Is NASH the same as cirrhosis?A few people who have fat in their liver develop NASH. If you have NASH, you may have symptoms that could take years for them to develop. If liver damage from NASH leads to permanent scarring and hardening of your liver, this is called cirrhosis.
What is the difference between hepatic steatosis and NASH?Whereas simple steatosis is considered a benign condition, NASH represents a threatening disease state in view of its potential progression to fibrosis and cirrhosis in up to 30% of cases (3), putting these patients at risk for the development of hepatocellular carcinoma.
What stage of liver disease is NASH?Stage 2. Nonalcoholic steatohepatitis (NASH) is a more aggressive and serious form, in which the liver is inflamed and scarring starts. While NASH's effects are similar to the damage caused by alcohol, people affected by NASH tend to drink very little or not at all.
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Liver cirrhosis due to nash icd 10
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