Advanced liver fibrosis and care continuum in emergency department patients with chronic hepatitis C.
Adolescent
Adult
Aged
Alanine Transaminase
/ blood
Aspartate Aminotransferases
/ blood
Biomarkers
/ blood
Continuity of Patient Care
Emergency Medical Services
/ statistics & numerical data
Emergency Service, Hospital
Female
Hepatitis C, Chronic
/ complications
Humans
Liver Cirrhosis
/ diagnosis
Male
Middle Aged
Platelet Count
Predictive Value of Tests
RNA, Viral
/ blood
Retrospective Studies
Young Adult
CDC recommendations
Emergency department
HCV
HCV testing
Undiagnosed infection
Journal
The American journal of emergency medicine
ISSN: 1532-8171
Titre abrégé: Am J Emerg Med
Pays: United States
ID NLM: 8309942
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
23
05
2018
revised:
25
08
2018
accepted:
27
08
2018
pubmed:
10
11
2018
medline:
28
10
2019
entrez:
10
11
2018
Statut:
ppublish
Résumé
FIB-4, a non-invasive serum fibrosis index (which includes age, ALT, AST, and platelet count), is frequently available during ED visits. Our objective was to define 1-year HCV-related care outcomes of ED patients with known HCV, for the overall group, and both those with and without advanced fibrosis. As part of an ongoing HCV linkage-to-care (LTC) program, HCV-infected ED patients were identified retrospectively via medical record review. Components of FIB-4 were abstracted, and patients with an FIB-4 > 3.25 were classified with advanced fibrosis and characterized with regards to downstream HCV care continuum outcomes at one-year after enrollment. Of the 113 patients with known HCV, 38 (33.6%) had advanced fibrosis. One-year outcomes along the HCV care continuum after ED encounter for 'all' 113, 75 'without advanced fibrosis', and 38 'advanced fibrosis' patients, respectively, were as follows: agreeing to be linked to care [106 (93.8%), 72 (96.0%), 34 (89.5%)]; LTC [38 (33.6%), 21 (28.0%), 17 (44.7%)]; treatment initiation among those linked [16 (42.1%), 9 (42.9%), 7 (41.2%)]; sustained virologic response 4 weeks post-treatment among those treated [15 (93.8%), 9 (100.0%), 6 (85.7%)]; documented all-cause mortality [10 (8.8%), 3 (4.0%), 7 (18.4%)]. Notably, 70% of those who died had advanced fibrosis. For those with advanced liver fibrosis, all-cause mortality was significantly higher, than those without (18.4% versus 4.0%, p = 0.030). Over one-third of HCV-infected ED patients have advanced liver fibrosis, incomplete LTC, and higher mortality, suggesting this readily-available FIB-4 might be used to prioritize LTC services for those with advanced fibrosis.
Sections du résumé
BACKGROUND
FIB-4, a non-invasive serum fibrosis index (which includes age, ALT, AST, and platelet count), is frequently available during ED visits. Our objective was to define 1-year HCV-related care outcomes of ED patients with known HCV, for the overall group, and both those with and without advanced fibrosis.
METHODS
As part of an ongoing HCV linkage-to-care (LTC) program, HCV-infected ED patients were identified retrospectively via medical record review. Components of FIB-4 were abstracted, and patients with an FIB-4 > 3.25 were classified with advanced fibrosis and characterized with regards to downstream HCV care continuum outcomes at one-year after enrollment.
RESULTS
Of the 113 patients with known HCV, 38 (33.6%) had advanced fibrosis. One-year outcomes along the HCV care continuum after ED encounter for 'all' 113, 75 'without advanced fibrosis', and 38 'advanced fibrosis' patients, respectively, were as follows: agreeing to be linked to care [106 (93.8%), 72 (96.0%), 34 (89.5%)]; LTC [38 (33.6%), 21 (28.0%), 17 (44.7%)]; treatment initiation among those linked [16 (42.1%), 9 (42.9%), 7 (41.2%)]; sustained virologic response 4 weeks post-treatment among those treated [15 (93.8%), 9 (100.0%), 6 (85.7%)]; documented all-cause mortality [10 (8.8%), 3 (4.0%), 7 (18.4%)]. Notably, 70% of those who died had advanced fibrosis. For those with advanced liver fibrosis, all-cause mortality was significantly higher, than those without (18.4% versus 4.0%, p = 0.030).
CONCLUSIONS
Over one-third of HCV-infected ED patients have advanced liver fibrosis, incomplete LTC, and higher mortality, suggesting this readily-available FIB-4 might be used to prioritize LTC services for those with advanced fibrosis.
Identifiants
pubmed: 30409463
pii: S0735-6757(18)30718-6
doi: 10.1016/j.ajem.2018.08.067
pmc: PMC6348121
mid: NIHMS1511747
pii:
doi:
Substances chimiques
Biomarkers
0
RNA, Viral
0
Aspartate Aminotransferases
EC 2.6.1.1
Alanine Transaminase
EC 2.6.1.2
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
286-290Subventions
Organisme : NIAID NIH HHS
ID : K01 AI100681
Pays : United States
Organisme : NIDA NIH HHS
ID : K24 DA034621
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA016065
Pays : United States
Organisme : NIDA NIH HHS
ID : R37 DA013806
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
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