CLINICAL UNDER-RECOGNITION OF SEVERE HYPERTRIGLYCERIDEMIA PATIENTS IN REAL WORLD PRACTICE: INSIGHTS FROM ICD CODING AND TRIGLYCERIDE LEVELS
Author(s)
Chuang Liu, PhD1, Sara Bruce Wirta, PhD2, Laura Stradford, MPH3, Carly Rich, BSc, MSc, PhD4, Nana Kragh, MSc5, Aletta Falk, MSc5.
1Sobi, Basel, Switzerland, 2Sobi, Solna, Sweden, 3Sobi, Inc., Waltham, MA, USA, 4Sobi, Upminster, United Kingdom, 5Sobi, Stockholm, Sweden.
1Sobi, Basel, Switzerland, 2Sobi, Solna, Sweden, 3Sobi, Inc., Waltham, MA, USA, 4Sobi, Upminster, United Kingdom, 5Sobi, Stockholm, Sweden.
OBJECTIVES: Severe hypertriglyceridemia (sHTG) increases the risk of acute pancreatitis, particularly at levels ≥880 mg/dL (10 mmol/L). However, identifying sHTG in real-world data remains challenging due to lack of specific ICD-coding. This analysis assessed the reliability of currently used ICD codes for hypertriglyceridemia, by evaluating their overlap with triglyceride laboratory values.
METHODS: TriNetX US Dataworks (2021-2025) from 18,147,424 patients with an ICD diagnosis code E78.1 (pure hyperglyceridemia), E78.2 (mixed hyperlipidemia), or E78.3 (hyperchylomicronemia) and/or triglyceride test at any time during the observation period was used. Patients identified by ICD diagnosis codes and/or triglyceride test results were compared. Triglycerides ≥150 mg/dL was used to define elevated levels.
RESULTS: This analysis included 4,912,658 (27.1%) patients identified by an ICD code and 17,113,284 (94.3%) patients with any triglyceride value (of these 3,878,518 [21.4%] had both; 1,034,140 [5.7%] had only ICD code; 13,234,766 [72.9%] had only triglyceride value). Of all patients with TG values, one third had levels ≥150 mg/dL. In the group of patients with ICD code and triglyceride value, the proportion of tests with triglycerides ≥880 mg/dL among patients who have ever received a diagnosis coded with E78.1, E78.2 or E78.3 was 6%, 1% and 8%, respectively. In patients with a triglyceride value ≥880 mg/dL who did not have an assigned HTG-related ICD code, most common diagnosis codes recorded within 7 days after the first triglyceride ≥880 mg/dL measurement reflected routine assessments or chronic conditions (I10 essential hypertension [21%], E78.5 unspecified hyperlipidemia [19%], E11.9 type 2 diabetes without complications [15%], Z00.00 general examination without abnormal findings [10%]).
CONCLUSIONS: Current ICD codes for HTG do not reliably identify sHTG patients; a combined approach using ICD codes and TG testing is needed for real-world HTG research. Clinical under‑recognition and misdiagnosis in coding practices highlight the need for improved TG testing and a dedicated sHTG-specific ICD code.
METHODS: TriNetX US Dataworks (2021-2025) from 18,147,424 patients with an ICD diagnosis code E78.1 (pure hyperglyceridemia), E78.2 (mixed hyperlipidemia), or E78.3 (hyperchylomicronemia) and/or triglyceride test at any time during the observation period was used. Patients identified by ICD diagnosis codes and/or triglyceride test results were compared. Triglycerides ≥150 mg/dL was used to define elevated levels.
RESULTS: This analysis included 4,912,658 (27.1%) patients identified by an ICD code and 17,113,284 (94.3%) patients with any triglyceride value (of these 3,878,518 [21.4%] had both; 1,034,140 [5.7%] had only ICD code; 13,234,766 [72.9%] had only triglyceride value). Of all patients with TG values, one third had levels ≥150 mg/dL. In the group of patients with ICD code and triglyceride value, the proportion of tests with triglycerides ≥880 mg/dL among patients who have ever received a diagnosis coded with E78.1, E78.2 or E78.3 was 6%, 1% and 8%, respectively. In patients with a triglyceride value ≥880 mg/dL who did not have an assigned HTG-related ICD code, most common diagnosis codes recorded within 7 days after the first triglyceride ≥880 mg/dL measurement reflected routine assessments or chronic conditions (I10 essential hypertension [21%], E78.5 unspecified hyperlipidemia [19%], E11.9 type 2 diabetes without complications [15%], Z00.00 general examination without abnormal findings [10%]).
CONCLUSIONS: Current ICD codes for HTG do not reliably identify sHTG patients; a combined approach using ICD codes and TG testing is needed for real-world HTG research. Clinical under‑recognition and misdiagnosis in coding practices highlight the need for improved TG testing and a dedicated sHTG-specific ICD code.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH29
Topic
Epidemiology & Public Health, Organizational Practices, Real World Data & Information Systems
Topic Subcategory
Disease Classification & Coding
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), Rare & Orphan Diseases