Icterus

The primary outcomes of cirrhosis, decompensated cirrhosis and HCC were defined using relevant physician visit, emergency department visit, hospital diagnosis, procedure, death and pathology codes (Table 1). A secondary outcome of 2-year all-cause mortality following last clinic visit was reported as an overall measure of patient severity of illness.
We built a series of diagnostic algorithms for each outcome ranging from simple (e.g. a single physician visit code) to more complex. This was done to identify the most parsimonious algorithms that were also highly sensitive and/or specific. We aimed to utilize all available health administrative data, and include both hospital-based and outpatient physician visits in our algorithms. Data sources were searched for relevant codes ten years prior to two years following the date of last clinical assessment (up to March 31^st, 2014 for TCLD and August 31^st, 2013 for KHSC).
Cirrhosis algorithms ranged from cirrhosis codes only to combinations with codes for chronic liver disease or any complication (decompensation events, HCC or liver transplant). Algorithms were combined in such a way as to make them more sensitive (“or” combinations) or specific (“and” combinations). As physician visit codes were noted to be less specific, we aimed to increase specificity by combining two or more such codes with hospitalization codes.
Decompensation algorithms included hospital diagnostic and death codes for portal hypertension, hepatorenal syndrome, jaundice, hepatic coma, hepatic failure, bleeding esophageal varices, gastric varices (bleeding not specified), and ascites. There were no physician visit codes available for decompensation events. We included procedure codes for endoscopy or insertion of Sengstaken tube for upper gastrointestinal bleeding, transjugular intrahepatic portosystemic shunt, and paracentesis. Since several of these procedures could occur for reasons other than decompensated cirrhosis (such as bleeding from an ulcer, or ascites secondary to an extra-hepatic malignancy), we tested combinations of procedure codes with a cirrhosis code from a physician visit.
Hepatocellular carcinoma algorithms ranged from simple (a single physician visit code) to more complex. We tested several combinations in order to optimise both sensitivity and specificity. We combined physician visit codes, hospital diagnostic codes, and cause of death codes. Further, we included procedure codes for radiofrequency ablation. Since this procedure can also be used to ablate tumours outside the liver (e.g., renal tumours), we combined ablation codes with an outpatient code for cirrhosis. Finally, we tested our results with and without anatomical and pathology codes from the Ontario Cancer Registry.

The initial screening identified a total of 213 PBM children during a period from January 1, 2015 to December 31, 2021.The inclusion criteria were as follows: (1) possession of pathological results from surgical specimens; (2) completion of surgery within 1 month after MR examination; and (3) availability of complete clinical data. The exclusion criteria were as follows: (1) incomplete clinical or pathological information; (2) patients diagnosed by CT scan alone, without MR scan; or (3) patients whose radiomics features could not be successfully extracted from the MR images. In total, 144 cases were included in the final analysis (Fig. 1).Fig. 1

Patient recruitment and study design

Due to the small number of cases at Xuzhou Children’s Hospital (n = 26), we did not adopt the conventional approach of using cases from one site as training cohort and cases from the other site for external validation. Instead, the 144 cases were randomly split at a 7:3 ratio to a training and a validation cohort. Clinical features considered as candidate variables for the model included sex, age (in years), abdominal pain, jaundice, fever, vomiting, liver dysfunction, pancreatitis, and elevated white blood cell (WBC) count. Liver dysfunction was defined as an elevation in serum aspartate aminotransferase (AST) and serum alanine aminotransferase (ALT) levels, while pancreatitis was defined as a preoperative serum amylase or lipase level of more than threefold the normal upper limit.