Indiana University School of Medicine Indianapolis, IN, United States
Sasha R. Kapil, MD1, Archita P. Desai, MD2, Anna Smith, RN, BSN2, Heather Adams, RN, BSN, CCRC2, Raj Vuppalanchi, MD2 1Indiana University School of Medicine, Indianapolis, IN; 2Indiana University, Indianapolis, IN
Introduction: Patients with compensated NASH cirrhosis and Model for End Stage Liver Disease (MELD) score < 15 are favored for clinical trial enrollment. Chart review to find eligible individuals can be inefficient and time consuming. This study aims to characterize a NASH Cirrhosis cohort identified from using a combination of ICD and MELD score and evaluate the degree of diagnostic certainty as guided by Liver Forum consensus definition for clinical trials (Noureddin M et al. Gastroenterology 2020;159:422–427).
Methods: Study cohort was identified using an electronic health record (EMR) search on adult patients seen at an academic institution between 3/2018 and 3/2020. Individuals with International Classification of Diseases (ICD) 10 codes K75.81 and either K74.6 or K74.69 were included and those with MELD > 15 or < 8 were excluded. Chart review was completed, and consensus definitions were used to assign certainty of diagnosis. ICD-10 codes for esophageal varices with bleeding (I85.11, I85.01), hepatic encephalopathy (HE, K72.90), and ascites (R18.8) were used to identify individuals with complications. In addition, descriptive statistics were used to characterize the cohort. Examined variables included certainty of diagnosis based on Consortium definitions and prevalence of decompensation events.
Results: Of 1022 patients who met search criteria, the mean age was 61 ± 12 years (57% women). In total, 697 (68%) were found to meet consensus definitions. 38% were classified as definitive, 58% as probable, and 3% as possible NASH cirrhosis (Figure 1A). Patients were divided into compensated (61%) and decompensated (39%) based on the presence of codes indicating any of 3 complications – variceal bleeding, ascites, hepatic encephalopathy (HE) (Figure 1B). HE was the most frequent decompensation (27%), followed by ascites (25%) and variceal bleed (2%).
Discussion: Our study shows that combination of ICD codes and MELD score yields approximately 4 out of 10 patients with compensated NASH cirrhosis by identifying those likely to be eligible and quickly excluding those who are not. Furthermore, despite low MELD score, 40% of the reviewed patients had complications. Earlier referral may increase likelihood that patients remain eligible for clinical trial enrollment and do not progress to decompensation.
Figure: Panel A: Characterization of a NASH Cirrhosis Cohort by Certainty of Diagnosis Panel B: Characterization of a NASH Cirrhosis Cohort by Decompensation Events
Sasha Kapil indicated no relevant financial relationships.
Archita Desai indicated no relevant financial relationships.
Anna Smith indicated no relevant financial relationships.
Heather Adams indicated no relevant financial relationships.
Raj Vuppalanchi indicated no relevant financial relationships.
Sasha R. Kapil, MD1, Archita P. Desai, MD2, Anna Smith, RN, BSN2, Heather Adams, RN, BSN, CCRC2, Raj Vuppalanchi, MD2. P2841 - Strategy of Combined ICD Codes and MELD Score Yields High Prevalence of Individuals With Non-Alcoholic Steatohepatitis (NASH) Cirrhosis That Are Eligible for Clinical Trials, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.