Development and performance of an algorithm to estimate the Child-Turcotte-Pugh score from a National Electronic Healthcare Database
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Background & methods The Child-Turcotte-Pugh (CTP) score is a widely used and validated predictor of long-term survival in cirrhosis. The CTP score is a composite of 5 subscores, 3 based on objective clinical laboratory values and 2 subjective variables quantifying the severity of ascites and hepatic encephalopathy. To date, no system to quantify CTP score from administrative databases has been validated. The Veterans Outcomes and Costs Associated with Liver Disease study is a multicenter collaborative study to evaluate the outcomes and costs of hepatocellular carcinoma in the U.S. Veterans Health Administration. We developed and validated an algorithm to calculate electronic CTP (eCTP) scores by using data from the Veterans Health Administration Corporate Data Warehouse.Methods Multiple algorithms for determining each CTP subscore from International Classification of Diseases version 9, Common Procedural Terminology, pharmacy, and laboratory data were devised and tested in 2 patient cohorts. For each cohort, 6 site investigators (Boston, Bronx, Brooklyn, Philadelphia, Minneapolis, and West Haven VA Medical Centers) were provided cases from which to determine validity of diagnosis, laboratory data, and clinical assessment of ascites and encephalopathy. The optimal algorithm (designated eCTP) was then applied to 30,840 cirrhotic patients alive in the first quarter of 2008 for whom 5-year overall and transplant-free survival data were available. The ability of the eCTP score and other disease severity scores (Charlson-Deyo index, Veterans Aging Cohort Study index, Model for End-Stage Liver Disease score, and Cirrhosis Comorbidity) to predict survival was then assessed by Cox proportional hazards regression.Results Spearman correlations for administrative and investigator validated laboratory data in the HCC and cirrhotic cohorts, respectively, were 0.85 and 0.92 for bilirubin, 0.92 and 0.87 for albumin, and 0.84 and 0.86 for international normalized ratio. In the HCC cohort, the overall eCTP score matched 96% of patients to within 1 point of the chart-validated CTP score (Spearman correlation, 0.81). In the cirrhosis cohort, 98% were matched to within 1 point of their actual CTP score (Spearman, 0.85). When applied to a cohort of 30,840 patients with cirrhosis, each unit change in eCTP was associated with 39% increase in the relative risk of death or transplantation. The Harrell C statistic for the eCTP (0.678) was numerically higher than those for other disease severity indices for predicting 5-year transplant-free survival. Adding other predictive models to the eCTP resulted in minimal differences in its predictive performance.Conclusion We developed and validated an algorithm to extrapolate an eCTP score from data in a large administrative database with excellent correlation to actual CTP score on chart review. When applied to an administrative database, this algorithm is a highly useful predictor of survival when compared with multiple other published liver disease severity indices.
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Ascites and hepatic encephalopathy were ascertained using ICD-9 and ICD-10 codes and medications using a validated algorithm.
“Ascites and hepatic encephalopathy were ascertained using ICD-9 and ICD-10 codes and medications using a validated algorithm and classified as none, mild or controlled, and severe or uncontrolled.28”
From Depression and anxiety are common among patients with cirrhosis (2022) · cites this paper as [28]
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Hatami, B., Asadi, F., Bayani, A., Zali, M. R., & Kavousi, K. (2022) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2022-0454 · Cited by 21 · see citing works
Survival Benefit of Liver Transplantation for Hepatocellular Carcinoma
Kanneganti, M., Mahmud, N., Kaplan, D. E., Taddei, T. H., & Goldberg, D. S. (2019) · Transplantation · doi:10.1097/tp.0000000000002816 · Cited by 21 · see citing works
Self-citationSLC4A11 mediates ammonia import and promotes cancer stemness in hepatocellular carcinoma
Elaimy, A. L., El-Derany, M. O., James, J. G., Wang, Z., Pearson, A. N., Holcomb, E. A., Huber, A. K., Gijón, M. A., Bell, H. N., Sanghvi, V. R., et al. (2024) · JCI Insight · doi:10.1172/jci.insight.184826 · Cited by 19 · see citing works
Models for acute on chronic liver failure development and mortality in a veterans affairs cohort
Xiao, K. Y., Hubbard, R. A., Kaplan, D. E., Taddei, T. H., Goldberg, D. S., & Mahmud, N. (2020) · Hepatology International · doi:10.1007/s12072-020-10060-y · Cited by 18 · see citing works
Self-citationAtsukawa, M., Tsubota, A., Kondo, C., Toyoda, H., Nakamuta, M., Takaguchi, K., Watanabe, T., Hiraoka, A., Uojima, H., Ishikawa, T., et al. (2021) · Hepatology Research · doi:10.1111/hepr.13739 · Cited by 18 · see citing works
Serper, M., Tapper, E. B., Kaplan, D. E., Taddei, T. H., & Mahmud, N. (2022) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000002011 · Cited by 18 · see citing works
Self-citationArney, J., Gray, C. P., Clark, J. A., Smith, D. L., Swank, A., Matlock, D. D., Melcher, J., Kanwal, F., & Naik, A. D. (2022) · PLoS ONE · doi:10.1371/journal.pone.0263874 · Cited by 17 · see citing works
Kaplan, D. E., Teerlink, C. C., Schwantes-An, T.-H. L., Norden‐Krichmar, T. M., DuVall, S. L., Morgan, T. R. M., Tsao, P. S., Voight, B. F., Lynch, J. A., Vujković, M., et al. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000487 · Cited by 17 · see citing works
Self-citationMezzacappa, C., Kim, N. J., Vutien, P., Kaplan, D. E., Ioannou, G. N., & Taddei, T. H. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.20963 · Cited by 16 · see citing works
Self-citationSingal, A. G., Chen, Y., Sridhar, S., Mittal, V., Fullington, H. M., Shaik, M., Waljee, A. K., & Tiro, J. A. (2021) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2021.02.038 · Cited by 16 · see citing works
Chi, X., Pan, J., Cai, J., Luo, G., Li, S., Yuan, D., Rui, J., Chen, W., & Hei, Z. (2018) · Medical Science Monitor · doi:10.12659/msm.910103 · Cited by 16 · see citing works
Zou, H., Tao, Y., & Wang, Z. (2017) · Oncology Letters · doi:10.3892/ol.2017.5919 · Cited by 15 · see citing works
Cacciola, I., Filomia, R., Alibrandi, A., Franzè, M. S., Caccamo, G., Maimone, S., Saitta, C., Saffioti, F., Squadrito, G., & Raimondo, G. (2017) · Liver International · doi:10.1111/liv.13649 · Cited by 15 · see citing works
Serper, M., Kaplan, D. E., Lin, M., Taddei, T. H., Parikh, N. D., Werner, R. M., & Tapper, E. B. (2021) · Digestive Diseases and Sciences · doi:10.1007/s10620-021-07150-8 · Cited by 15 · see citing works
Self-citationClinical outcomes and care for spontaneous bacterial peritonitis: A national cohort study
Serper, M., Tang, H., Zhang, S., McCullough, A. A., Kaplan, D. E., Taddei, T. H., & Mahmud, N. (2025) · Hepatology · doi:10.1097/hep.0000000000001251 · Cited by 14 · see citing works
Self-citationJohn, B. V., Doshi, A., Ferreira, R., Taddei, T. H., Kaplan, D. E., Spector, S. A., Deng, Y., Bastaich, D., & Dahman, B. A. (2022) · Hepatology · doi:10.1002/hep.32619 · Cited by 13 · see citing works
Self-citationMezzacappa, C., Ochoa‐Allemant, P., Serper, M., Taddei, T. H., John, B. V., Kaplan, D. E., & Mahmud, N. (2024) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2024.10.035 · Cited by 13 · see citing works
Self-citationNjei, B. M., Mezzacappa, C., John, B. V., Serper, M., Kaplan, D. E., Taddei, T. H., & Mahmud, N. (2025) · Digestive Diseases and Sciences · doi:10.1007/s10620-024-08764-4 · Cited by 15 · see citing works
Self-citationDuan, T., Jiang, H., Xia, C., Chen, J., Cao, L., Ye, Z., Wei, Y., Song, B., & Lee, J. M. (2020) · Frontiers in Medicine · doi:10.3389/fmed.2020.00215 · Cited by 12 · see citing works
Mezzacappa, C., Mahmud, N., Serper, M., John, B. V., Taddei, T. H., & Kaplan, D. E. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000344 · Cited by 12 · see citing works
Self-citationZhang, H.-C. (2016) · World Journal of Gastroenterology · doi:10.3748/wjg.v22.i22.5276 · Cited by 12 · see citing works
Cai, W., Zheng, B., Lin, X., Wu, W., & Chen, C. (2022) · International Journal of General Medicine · doi:10.2147/ijgm.s359918 · Cited by 11 · see citing works
Algorithms to Identify Alcoholic Hepatitis Hospitalizations in Patients with Cirrhosis
Panchal, S., Kaplan, D. E., Goldberg, D. S., & Mahmud, N. (2022) · Digestive Diseases and Sciences · doi:10.1007/s10620-021-07321-7 · Cited by 11 · see citing works
Self-citationKaplan, D. E. (2016) · Digestive Diseases and Sciences · doi:10.1007/s10620-016-4378-9 · Cited by 11 · see citing works
Self-citationThe Use of Administrative Data to Investigate the Population Burden of Hepatic Encephalopathy
Bloom, P. P., & Tapper, E. B. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9113620 · Cited by 10 · see citing works
Gao, S., Han, L., Fan, Y., & Wang, K. (2022) · European journal of medical research · doi:10.1186/s40001-022-00891-w · Cited by 9 · see citing works
Wu, B., Hu, X., Jin, H., Zhou, L., Zhang, D., Man, Z., Wang, Y., Yang, S., Pang, Q., Liu, H., et al. (2019) · Medicine · doi:10.1097/md.0000000000017394 · Cited by 9 · see citing works
Mahmud, N., Goldberg, D. S., Kaplan, D. E., & Serper, M. (2020) · Hepatology Communications · doi:10.1002/hep4.1638 · Cited by 9 · see citing works
Self-citationPrognostic significance of mild ascites in patients with cirrhosis
Lugon, N. C., Rabiee, A., Mezzacappa, C., Kaplan, D. E., Taddei, T. H., & García–Tsao, G. (2025) · Hepatology · doi:10.1097/hep.0000000000001452 · Cited by 8 · see citing works
Self-citationWang, R. X., Serper, M., Taddei, T. H., Kaplan, D. E., & Mahmud, N. (2024) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000002976 · Cited by 8 · see citing works
Self-citationKaplan, D. E., Mehta, R. L., D’Addeo, K., Gade, T. P. F., & Taddei, T. H. (2018) · Journal of Vascular and Interventional Radiology · doi:10.1016/j.jvir.2017.11.033 · Cited by 8 · see citing works
Self-citationCabrera, R., Singal, A. G., Colombo, M., Kelley, R. K., Lee, H., Mospan, A. R., Meyer, T., Newell, P., Parikh, N. D., Sangro, B., et al. (2020) · Hepatology Communications · doi:10.1002/hep4.1652 · Cited by 8 · see citing works
Mahmud, N., Reddy, K. R., Taddei, T. H., & Kaplan, D. E. (2022) · Digestive Diseases and Sciences · doi:10.1007/s10620-022-07680-9 · Cited by 8 · see citing works
Self-citationShaffer, L. R., Kaplan, D. E., Taddei, T. H., & Mahmud, N. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000129 · Cited by 8 · see citing works
Self-citationPredictive factors for re-bleeding of esophageal varices in hospitalized patients
Yaru, H., Mei, Z., Li, K., Ruyue, C., & Liu, M. (2022) · Cellular and Molecular Biology · doi:10.14715/cmb/2022.68.2.26 · Cited by 7 · see citing works
Mahmud, N., Asrani, S. K., Reese, P. P., Kaplan, D. E., Taddei, T. H., Nadim, M. K., & Serper, M. (2021) · Digestive Diseases and Sciences · doi:10.1007/s10620-021-06943-1 · Cited by 7 · see citing works
Self-citationPolanco, P. M., Ju, M. R., Chansard, M., Augustine, M. M., Meier, J., Mortensen, E. M., Zeh, H. J., & Yopp, A. C. (2022) · Annals of Surgical Oncology · doi:10.1245/s10434-022-11897-3 · Cited by 7 · see citing works
Ju, M. R., Karalis, J. D., Chansard, M., Augustine, M. M., Mortensen, E. M., Wang, S. C., Porembka, M. R., Zeh, H. J., Yopp, A. C., & Polanco, P. M. (2022) · Annals of Surgical Oncology · doi:10.1245/s10434-022-12390-7 · Cited by 7 · see citing works
Patel, A., Walling, A. M., Kanwal, F., Serper, M., Hernáez, R., Sundaram, V., Kaplan, D. E., Taddei, T. H., & Mahmud, N. (2023) · JHEP Reports · doi:10.1016/j.jhepr.2023.100976 · Cited by 7 · see citing works
Self-citationGhandour, B., Tapper, E. B., Kaplan, D. E., Serper, M., & Mahmud, N. (2024) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2024.06.016 · Cited by 6 · see citing works
Self-citationSalama, M., Darwesh, N., Elsabaawy, M., Abdelsameea, E., Gomaa, A. I., & Sabry, A. (2024) · Journal of Hepatocellular Carcinoma · doi:10.2147/jhc.s475810 · Cited by 5 · see citing works
Durkin, C., Schaubel, D. E., Kaplan, D. E., Mahmud, N., & Bittermann, T. (2024) · Clinical and Translational Gastroenterology · doi:10.14309/ctg.0000000000000791 · Cited by 5 · see citing works
Self-citationRecent TIPS increases postoperative mortality: A national cohort study
Tang, H., Kaplan, D. E., Abu‐Gazala, S., & Mahmud, N. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000577 · Cited by 5 · see citing works
Self-citationCrooks, C. J., West, J., & Jepsen, P. (2018) · Clinical Epidemiology · doi:10.2147/clep.s147535 · Cited by 5 · see citing works
Chapin, S. E., Kaplan, D. E., Taddei, T. H., & Mahmud, N. (2023) · JHEP Reports · doi:10.1016/j.jhepr.2023.100740 · Cited by 4 · see citing works
Self-citationSilvey, S. G., Patel, N., Davis, B., Sterling, R. K., Aljabi, A., Shenoy, A., Puri, P., Fuchs, M. A., BUSH, B. J., & Bajaj, J. S. (2025) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000003824 · Cited by 4 · see citing works
Albumin for Spontaneous Bacterial Peritonitis: Care Variation, Disparities, and Outcomes
Serper, M., Pulaski, M., Zhang, S., Taddei, T. H., Kaplan, D. E., & Mahmud, N. (2024) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000003190 · Cited by 4 · see citing works
Self-citation
- Authors
- Kaplan, D. E., Dai, F., Aytaman, A., Baytarian, M., Fox, R., Hunt, K., Knott, A., Pedrosa, M., Pocha, C., Mehta, R., Duggal, M., Skanderson, M., Valderrama, A., & Taddei, T. H.
- Affiliations
- Philadelphia VA Medical Center (US)
- VA Connecticut Healthcare System (US)
- VA NY Harbor Healthcare System (US)
- VA Boston Healthcare System (US)
- San Francisco VA Medical Center (US)
- James J. Peters VA Medical Center (US)
- Minneapolis VA Health Care System (US)
- Corresponding author
- Kaplan, David E.
- ORCID
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2015-12
- Volume
- 13
- Issue
- 13
- Pages
- 2333-2341.e6
- ISSN
- 1542-3565 (ISSN-L)
- PMC
- PMC4655141
- OpenAlex
- W901036528
- Cited by
- 139
- References
- 31
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 18 · 2023: 11 · 2022: 20 · 2021: 14 · 2020: 18 · 2019: 16 · 2018: 7 · 2017: 8 · 2016: 6
- FWCI
- 4.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (VA999999)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK034989)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- Child-Pugh score, liver cirrhosis, electronic health records, administrative data, algorithm validation, ascites, hepatic encephalopathy, MELD score, overall survival, transplant-free survival, hepatocellular carcinoma, veterans, Veterans Health Administration
- MeSH terms
- Algorithms, Ascites, Female, Hepatic Encephalopathy, Humans, Liver Cirrhosis, Male, Middle Aged, Prognosis, Severity of Illness Index, Survival, United States, Cohort Studies, Databases, Factual, Electronic Health Records
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