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Hepatology Communications; PubMed Central
Article . Other literature type . 2021 . Peer-reviewed
License: CC BY NC ND
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Hepatology Communications
Article . 2021
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a methodology to generate longitudinally updated acute on chronic liver failure prognostication scores from electronic health record data

Authors: Jin Ge; Nader Najafi; Wendi Zhao; Ma Somsouk; Margaret Fang; Jennifer C. Lai;

a methodology to generate longitudinally updated acute on chronic liver failure prognostication scores from electronic health record data

Abstract

Queries of electronic health record (EHR) data repositories allow for automated data collection. These techniques have not been used in hepatology due to the inability to capture hepatic encephalopathy (HE) grades, which are inputs for acute‐on‐chronic liver failure (ACLF) models. Here, we describe a methodology to use EHR data to calculate rolling ACLF scores. We examined 239 patient admissions with end‐stage liver disease from July 2014 to June 2019. We mapped EHR flowsheet data to determine HE grades and calculated two longitudinally updated ACLF scores. We validated HE grades and ACLF diagnoses by chart review and calculated sensitivity, specificity, and Cohen’s kappa. Of 239 patient admissions analyzed, 37% were women, 46% were non‐Hispanic white, median age was 60 years, and the median Model for End‐Stage Liver Disease–Na score at admission was 25. Of the 239, 7% were diagnosed with ACLF as defined by the North American Consortium for the Study of End‐Stage Liver Disease (NACSELD) diagnostic criteria at admission, 27% during the hospitalization, and 9% at discharge. Forty percent were diagnosed with ACLF by the European Association for the Study of the Liver– Chronic Liver Failure Consortium (CLIF‐C) diagnostic criteria at admission, 51% during the hospitalization, and 34% at discharge. From the chart review of 51 admissions, we found sensitivities and specificities for any HE (grades 1‐4) were 92%‐97% and 76%‐95%, respectively; for severe HE (grades 3‐4), sensitivities and specificities were 100% and 78%‐98%, respectively. Cohen’s kappa between flowsheet and chart review of HE grades ranged from 0.55 to 0.72. Sensitivities and specificities for NACSELD‐ACLF diagnoses were 75%‐100% and 96%‐100%, respectively; for CLIF‐C‐ACLF diagnoses, these were 91%‐100% and 96‐100%, respectively. We generated approximately 28 unique ACLF scores per patient per admission day. Conclusion: We developed an informatics‐based methodology to calculate longitudinally updated ACLF scores. This opens new analytic potentials, such as big data methods, to develop electronic phenotypes for patients with ACLF.

Country
United States
Keywords

Biomedical and Clinical Sciences, Liver Disease, Clinical Sciences, Chronic Liver Disease and Cirrhosis, 610, Clinical sciences, RC799-869, Original Articles, Diseases of the digestive system. Gastroenterology, Oral and gastrointestinal, 7.3 Management and decision making, Good Health and Well Being, Digestive Diseases

  • BIP!
    Impact byBIP!
    citations
    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    5
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Average
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
5
Top 10%
Average
Top 10%
Green
gold