* CONDITION * Advanced Decompensated Cirrhosis

[lshbz1]

We will create a list of diagnoses of advanced decompensated cirrhosis, which is a contraindication of Paxlovid for non-hospitalised COVID-19 patients.

[speed-vm]

@lshbz1 hello! I am assigned to help codelists for advanced decompensated cirrhosis and ascitic drains.

Just seeing comment above, are you going to provide a list of diagnoses on which I should base codelist or are you starting one yourself?

Thank you

[lshbz1]

Hi Vicky, sorry for the confusion, only need a codelist (both snomed and icd) for one diagnosis (advanced decompensated cirrhosis) but it may have different terminology...

[speed-vm]

Description User Requirements Codelist to identify patients with advanced decompensated cirrhosis.

Methodology Search Terms: Cirrhosis Cirrhosis of the liver Decompensated Decompensated liver Child pugh C Ascites Oesophageal varices Portal Hypertension Hepatic encephalopathy

Inclusion Criteria for Codes Codes indicating decompensated cirrhosis, including jaundice, ascites, hepatic encephalopathy, hepatorenal syndrome or variceal haemorrhage (portal hypertension). ?consider rifaximin as a medicine proxy

Exclusion Criteria for Codes

Borderline Cases to Highlight:

First codelist: TBD

@lshbz1 I'm just looking at what to include/exclude in the list. What do you think about the above in terms of inclusion criteria. I think it depends on the ultimate use of the code and how inclusive you wish to be? My main concern is that you aren't going to identify patients that have advanced decompensation

If you are happy, I will go ahead with the above, but would be grateful for your thoughts before I go ahead!

Refs: https://www.bsg.org.uk/wp-content/uploads/2020/08/[Cirrhosis-discharge-bundle-long-V1.1-BSG-BASL-25-08-2020.pdf](https://www.bsg.org.uk/wp-content/uploads/2020/08/Cirrhosis-discharge-bundle-long-V1.1-BSG-BASL-25-08-2020.pdf)

Mansour D, McPherson S. Management of decompensated cirrhosis. Clin Med (Lond). 2018;18(Suppl 2):s60-s65. doi:10.7861/clinmedicine.18-2-s60

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334027/pdf/clinmed-18-2s-s60.pdf

[lshbz1]

Hi Vicky, I agree with the inclusion criteria. I also did a quick search for Snomed codes and didn't find exact match of the term "advanced decompensated cirrhosis", so the broad definition is needed. This codelist will be mainly used for identifying and excluding patients that shouldn't be prescribed Paxlovid. rifaximin seems reasonable but it's already included in the Paxlovid Drug Interactions codelist, so maybe we don't need to include it here. Many thanks for your help!

[speed-vm]

@lshbz1 great, I will work on the above and keep you updated. I work Mondays and Tuesdays and so realistically I will next be in touch at the beginning of next week with progress. Thank you

[speed-vm]

Hi @lshbz1, have made some progress with the code list SNOMED today, I will share with the team for comments and review.

SNOMED hierachy background comment Decompensated cirrhosis of the liver as a SNOMED term is a child to parents Hepatic Failure and _Cirrhosis of the Liver. All relevant terms from 'child terms' from these two parents have been included as well as the conditions indicative of decompensated liver disease including codes for ascites, hepatic encephalopathy, hepatorenal syndrome or variceal haemorrhage (portal hypertension).

Inclusion Criteria Conditions indicative of decompensated liver disease including codes for ascites, hepatic encephalopathy, hepatorenal syndrome or variceal haemorrhage (portal hypertension).

Exclusion Criteria for Codes Fetal cirrhosis Early cirrhosis Jaundice omitted as non-specific

Borderline Cases to Highlight: Codes describing acute hepatic injury - for example side effect of medication. May not capture the advanced nature of liver disease that looking to identify.

Codelist link: https://www.opencodelists.org/codelist/user/speed-vm/condition-advanced-decompensated-cirrhosis-of-the-liver/5c4c47b4/#search-results

[richiecroker]

@speed-vm can we discuss at CI team meeting on Monday please

[speed-vm]

Hi @richiecroker

Metadata and title of codelist updated as per team discussion this morning. Discussion was around the broad nature of the codelist, and team felt better to make that clear in the description and title

Updated codelist: https://www.opencodelists.org/codelist/user/speed-vm/condition-advanced-decompensated-cirrhosis-of-the-liver/1aba2c18/

[speed-vm]

Whilst looking at existing work for identification of end stage liver disease. Have found a paper describing a validation study of ICD-9 codes to identify end stage liver disease

In this paper, they suggest that we identifying those with cirrhosis and a decompensation event (eg varices). As a compromise and to be inclusive, I have generated two codelists (1x SNOMED and 1 x ICD-10) indicating cirrhosis or a decompensation event.

ICD-10 codes https://www.opencodelists.org/codelist/user/speed-vm/condition-advanced-decompensated-liver-disease-and-associated-conditions-icd-10/523e926e/#tree

SNOMED https://www.opencodelists.org/codelist/user/speed-vm/condition-advanced-decompensated-cirrhosis-of-the-liver/071038cf/

[richiecroker]

@speed-vm happy with both ICD-10 and SNOMED codelists

[speed-vm]

@lshbz1 these codelists have now been published.

[lshbz1]

Many thanks Vicky and Richard!