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Last Post 04 Sep 2014 12:00 AM by  SuperUser Account
Suggested changes to Hepatitis-related codes in tblCEP
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28 Apr 2014 12:00 AM

    Dear All

    I had the chance to discuss the hepatitis codes from tblCEP with Massimo Puoti and Robert Zangerle. To improve the tool for an adequate clinical classification of hepatic liver diseases we suggest the following changes:

    New type of event: Fibroscan IQR

    In addition to the Fibroscan stiffness (CEP_ID="FIBS") with the elasticity value in CEP_V (CEP_ID="FIBS", CEP_SPEC=elasticity in KPa) we need to also collect the interquartile range (IQR) of the measurements. An IQR greater than 30% of the stiffness value indicates that the results for stiffness need to be treated with caution.

    Proposed change:
    1) Add CEP_ID="FIBI" with a corresponding value for the IQR in CEP_V

    Oesophageal varices need specification whether bleeding or not

    Proposed changes:
    2) Replace CEP_ID="OESO" with CEP_ID="OESV"

    Add the following codes for CEP_ID="OESV" in CEP_SPEC:
    3) "BLNO" without bleeding
    4) "BLYE" with bleeding
    5) "" leave empty if information on bleeding not available

    Ascites need specification whether controlled with diuretics or not

    Proposed changes:
    Add the following codes for CEP_ID="ASCI" in CEP_SPEC:
    6) "DICY" Diuretic controlled yes
    7) "DICN" Diuretic controlled no
    8) "" leave empty if information not available


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    13 Jun 2014 12:00 AM


    The suggested changes could be relevant for a few detailed studies. In EuroSIDA we don't collect data with that level of detail.

    If you want to know the IQR of the fibroscan, do you then also suggest to collect the length of liver biopsies where short biopsies also should be treated with caution?

    For information on non-bleeding varices to be clinically useful, don´t you also want to know the size of the varices,and whether intervention has taking place, for example banding.

    For the "DICY" Diuretic controlled yes, do you mean if diuretics are given or whether there is a clinical effect of diuretics? This would require a definition of "controlled" to be operationally useful. Some patients also undergo paracentesis in addition to receiving diuretics. Should that information also be collected?

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    04 Sep 2014 12:00 AM


    Dear all

    I just had a discussion with a senior hepatologist. He agrees that there is no general standard on how to stage chronic liver disease in general which we could simply copy-paste. He completely agrees with the comments made by Lars (Message #141):

    information on biopsy length
    size of varizes (give definitions)
    interventions on varizes (e.g. banding)
    operational definition of ascites control with diuretics (subjective by patient, ultrasound ..)

    That level of detail clearly can only be collected in a prospective way.

    It seems to me that this discussion needs further detailed input from clinicians.

    Any volunteers?

    Bruno
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