ICD-10 code vs LASSO model: PPV for PSC

What is known

• ICD-10 code alone: PPV 68.8% (sensitivity 87.6%, c-statistic 0.87); LASSO model: PPV 70.7% (sensitivity 87.4%, c-statistic 0.92). ¹
• The LASSO model added alkaline phosphatase >120 IU/L, ursodiol use, IBD, and history of cholangitis to the ICD-10 code. ¹
• Authors concluded the optimized algorithm was only slightly improved and the ICD-10 code alone was sufficient for identifying PSC. ¹

What is unknown / caveats

• Single retrospective study at one institution
• PPV likely inflated: cohort enriched with patients likely to have PSC, and negative predictive value could not be calculated
• Confidence intervals for the two PPVs overlap, so the difference may not be meaningful
• The PPV advantage of the LASSO model over the ICD-10 code is small and within overlapping confidence intervals.

References

1. Wang M, Dao M, Delk M, Fenton C, Li MY, Rubin JB, Ge J, Lai JC, Li M. Identification of primary sclerosing cholangitis: ICD-10 code validation and comparison with a large language model approach. Res Sq. 2026. PMID: 41960311.

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