Validity of Diagnosis of Disseminated Intravascular Coagulation Based on International Classification of Diseases Coding in a Claims Database

Abstract

Background

Accuracy in diagnoses recorded using the International Classification of Diseases (ICD) coding is the most important element ensuring the foundation of research using real-world data analyses.

Objective

To evaluate the validity of ICD coding for diagnoses of disseminated intravascular coagulation (DIC) using the International Society on Thrombosis and Haemostasis (ISTH) overt DIC criteria and the Japanese Association for Acute Medicine (JAAM) DIC criteria as reference standards.

Methods

This retrospective observational study included adult hospitalized patients diagnosed as having diseases potentially causing DIC extracted from a part of a large-scale database in Japan. The index test was a diagnosis of DIC based on the ICD-10 codes. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using ISTH overt DIC criteria and JAAM-2 DIC criteria as the reference standards. We also conducted subgroup analyses according to the underlying diseases.

Results

We included 84,300 patients in this study. In the overall study population, sensitivity, specificity, PPV, and NPV of the ICD-based diagnosis for ISTH criteria were 26.28, 98.10, 35.12, and 97.14%, respectively. In subgroup analyses according to the underlying disease, sensitivity ranged from 9.48 to 52.08%, and specificity ranged from 96.94 to 99.47%. The accuracy of the ICD-based diagnosis for JAAM-2 criteria was similar to that for ISTH criteria.

Conclusion

Identification of DIC patients using ICD-10 codes had relatively low sensitivity but very high specificity for DIC diagnostic criteria. Approximately 65% of patients identified by ICD coding are likely to meet the JAAM-2 DIC criteria.

Keywords

disseminated intravascular coagulation - diagnosis - sepsis - leukemia - cancer

• References

• 1 Taylor Jr FB, Toh CH, Hoots WK, Wada H, Levi M. Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001; 86 (05) 1327-1330
• 2 Yamakawa K, Ohbe H, Taniguchi K, Matsui H, Fushimi K, Yasunaga H. Time trends of the outcomes and treatment options for disseminated intravascular coagulation: a nationwide observational study in Japan. JMA J 2020; 3 (04) 313-320
• 3 Gando S, Shiraishi A, Yamakawa K. et al; Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group. Role of disseminated intravascular coagulation in severe sepsis. Thromb Res 2019; 178: 182-188
• 4 Gando S, Saitoh D, Ogura H. et al; Japanese Association for Acute Medicine Sepsis Registry Study Group. A multicenter, prospective validation study of the Japanese Association for Acute Medicine disseminated intravascular coagulation scoring system in patients with severe sepsis. Crit Care 2013; 17 (03) R111
• 5 Oshiro A, Yanagida Y, Gando S, Henzan N, Takahashi I, Makise H. Hemostasis during the early stages of trauma: comparison with disseminated intravascular coagulation. Crit Care 2014; 18 (02) R61
• 6 Rattray DD, O'Connell CM, Baskett TF. Acute disseminated intravascular coagulation in obstetrics: a tertiary centre population review (1980 to 2009). J Obstet Gynaecol Can 2012; 34 (04) 341-347
• 7 Umemura Y, Nishida T, Yamakawa K, Ogura H, Oda J, Fujimi S. Anticoagulant therapies against sepsis-induced disseminated intravascular coagulation. Acute Med Surg 2023; 10 (01) e884
• 8 Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348 (16) 1546-1554
• 9 Pine M, Jordan HS, Elixhauser A. et al. Enhancement of claims data to improve risk adjustment of hospital mortality. JAMA 2007; 297 (01) 71-76
• 10 Hisamune R, Mochizuki K, Yamakawa K. Real-world evidence on disseminated intravascular coagulation from Japan. Acute Med Surg 2023; 10 (01) e836
• 11 World Health Organization. International Classification of Diseases (ICD). August 11, 2024 at: https://www.who.int/standards/classifications/classification-of-diseases
• 12 Rudd KE, Johnson SC, Agesa KM. et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 2020; 395 (10219): 200-211
• 13 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (05) 373-383
• 14 Quan H, Sundararajan V, Halfon P. et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43 (11) 1130-1139
• 15 Umemura Y, Yamakawa K, Hayakawa M, Hamasaki T, Fujimi S. Japan Septic Disseminated Intravascular Coagulation (J-Septic DIC) study group. Screening itself for disseminated intravascular coagulation may reduce mortality in sepsis: a nationwide multicenter registry in Japan. Thromb Res 2018; 161: 60-66
• 16 Yamakawa K, Umemura Y, Mochizuki K. et al. Proposal and validation of a clinically relevant modification of the Japanese Association for Acute Medicine disseminated intravascular coagulation diagnostic criteria for sepsis. Thromb Haemost 2024; 124 (11) 1003-1012
• 17 US Food and Drug Administration. Real-World Evidence. https://www.fda.gov/science-research/science-and-research-special-topics/real-world-evidence . Accessed April 15, 2024
• 18 Kahn JM, Davis BS, Yabes JG. et al. Association Between State-Mandated Protocolized Sepsis Care and In-hospital Mortality Among Adults With Sepsis. JAMA 2019; 322 (03) 240-250
• 19 Evans L, Rhodes A, Alhazzani W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47 (11) 1181-1247
• 20 Ushio N, Wada T, Ono Y, Yamakawa K. Sepsis-induced disseminated intravascular coagulation: an international estrangement of disease concept. Acute Med Surg 2023; 10 (01) e00843
• 21 Yamana H, Horiguchi H, Fushimi K, Yasunaga H. Comparison of procedure-based and diagnosis-based identifications of severe sepsis and disseminated intravascular coagulation in administrative data. J Epidemiol 2016; 26 (10) 530-537