studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 1085A
Because AI/AN persons infected with HCV genotype 3 are at
high risk for developing advanced fibrosis, ESLD, HCC, and
LRD, they should be prioritized for earlier antiviral treatment.
Disclosures:
The following authors have nothing to disclose: Anne C. Moorman, Yueren Zhou,
Loralee B. Rupp, Joseph A. Boscarino, Connie M. Trinacty, Scott D. Holmberg
Disclosures:
Lisa J. Townshend-Bulson - Grant/Research Support: Gilead
James E. Gove - Grant/Research Support: Gilead Sciences
Annette Hewitt - Grant/Research Support: gilead
Julia N. Plotnik - Grant/Research Support: Gilead
Chriss E. Homan - Grant/Research Support: Gilead
Hannah G. Espera - Grant/Research Support: Gilead
Youssef Barbour - Grant/Research Support: Gilead
The following authors have nothing to disclose: Brian J. McMahon, Dana J.
Bruden, Stephen Livingston, Susan Negus, Mary Snowball, Michael Bruce, Philip
R. Spradling, Prabhu P. Gounder
1799
The Utility and Limitations of Electronic Medical Records:
Predictive Values of ICD9 Codes indicating Chronic HCV
Infection
Anne C. Moorman 1 , Yueren Zhou 2 , Loralee B. Rupp 2 , Joseph A.
Boscarino 3 , Connie M. Trinacty 4 , Scott D. Holmberg 1 ; 1 Division of
Viral Hepatitis, C DC, Atlanta, GA; 2 Henry Ford Health Systems,
Detroit, MI; 3 Geaisinger Health System, Danville, PA; 4 Kaiser Permanente-Hawaii,
Honolulu, HI
Objective. With increasing analysis of electronic medical
records (EMR) in the United States, the predictive values of
the International Classification of Diseases, 9th revision (ICD-
9) coding system for chronic hepatitis C virus (HCV) infection
warrant evaluation. Methods. Patients in the Chronic Hepatitis
Cohort Study (CCHeCS) with chronic HCV infection, confirmed
by laboratory data and abstractor review (a ‘gold standard’),
were compared to “chronically infected cases” identified by
electronic medical records (EMRs) ICD9 codes of adult patients
who accessed services from 2006 to 2012 at four integrated
healthcare systems in the United States. Results. Of over 1.6
million adult patients at the 4 large medical systems in CHeCS,
11,354 were confirmed as having chronic HCV infection.
Having an EMR with one ICD-9 code for HCV yielded good
sensitivity and positive predictive value (PPV) for true HCV
infection, but poor specificity (Table), ie.e many (n=724) who
were listed as having HCV infection but were not infected.
Use of two hepatitis C-specific ICD-9 codes (6 or more months
apart) improved the specificity with some loss of sensitivity,
and the negative predictive value (NPV, non-cases accurately
identified as non-cases) was poor (Table) . Because test codes
were not standardized between laboratories, and viral load
results were in text fields, distinguishing true from questionable
or non-cases of HCV infection required extensive visual inspection
and data processing. Discussion. EMRs, especially ICD9
(or ICD10) codes, are increasingly used and analyzed in the
United States, but these have imperfect sensitivity, specificity,
and positive and negative predictive values for hepatitis C, and
require considerable human review and judgment.
1800
Liver fibrosis stage and comorbidities in persons with
diagnosed hepatitis C infection, Chronic Hepatitis Cohort
Study (CHeCS)
Fujie Xu 1 , Jian Xing 1 , Anne C. Moorman 1 , Stuart C. Gordon 2 ,
Loralee B. Rupp 2 , Mei Lu 2 , Philip R. Spradling 1 , Eyasu H. Teshale 1 ,
Joseph A. Boscarino 3 , Mark A. Schmidt 4 , Connie M. Trinacty 5 ,
Scott D. Holmberg 1 ; 1 Division of Viral Hepatitis, Centers for Disease
Control and Prevention, Atlanta, GA; 2 Henry Ford Health System,
Detroit, MI; 3 Geisinger Health System, Danville, PA; 4 Kaiser
Permanente- Northwest, Portland, OR; 5 Kaiser Permanente-Hawaii,
Honolulu, HI
Background and Aims: The Chronic Hepatitis Cohort Study
(CHeCS), a dynamic, prospective, observational cohort study,
was created to study the natural history of chronic viral hepatitis
in the United States. This report described HCV cohort patients’
demographic and clinical characteristics, comorbidities, treatment
and treatment outcomes of cohort patients at the end of
2012. Methods: CHeCS patients were drawn from about 2.7
million persons aged 18 years or older who had a clinical service
visit from January 2006-December 2012 at 4 integrated
healthcare systems in Detroit, Michigan; Danville, Pennsylvania;
Portland, Oregon; and Honolulu, Hawaii. We analyzed
clinical data obtained from electronic medical records and
manual chart review for HCV-infected patients who were alive
but never had a liver transplant as of December 2012, including
patients who achieved SVR with altered natural history.
Patient’s current fibrosis stage was based on latest FIB4 scores
derived from blood tests or biopsy results, if available. Laboratory
tests and ICD-9 codes were used to identify patients with
co-infections and comorbidities. Results: Of 15,940 total HCV
cohort patients 2006-12, 11,294 were alive of Dec 2012;
among these patients mean age at the end of observation was
54 years; 58% were male, 55% white and 22% black. Only
1,355 (9%) of the cohort had achieved SVR, which occurred
a median of 4.8 years previously. Of 9,975 patients without
SVR, 2,553 (25.6%) had ever been treated during a median
followup of 5.3 years. Viral load data was available for 7,189
patients; of these, 14% had 6 million IU/ml or higher (most
recent test among those untreated and the latest before initial
treatment among those treated). Impaired kidney function with
eGFR