McGinn Thomas, O'Connor-Moore Nicola, Alfandre David, Gardenier Donald, Wisnivesky Juan
Division of General Internal Medicine, Mount Sinai School of Medicine, 1470 Madison Ave, Box 1087, New York, NY 10029, USA.
Arch Intern Med. 2008 Oct 13;168(18):2009-13. doi: 10.1001/archinte.168.18.2009.
Although hepatitis C virus (HCV) has an estimated national prevalence of 1.8%, testing rates are lower than those recommended by guidelines, particularly in primary care. A critical step is the ability to identify patients at increased risk who should be screened. We sought to prospectively derive and validate a clinical predication tool to assist primary care providers in identifying patients who should be tested for HCV antibodies.
A total of 1000 randomly selected patients attending an inner-city primary care clinic filled out a 27-item questionnaire assessing 5 HCV risk factor domains: work, medical, exposure, personal care, and social history. Afterward, the patients underwent HCV antibody testing. Multivariable logistic regression analysis was performed to identify risk factors associated with HCV antibodies.
There was an 8.3% (95% confidence interval, 6.7%-10.2%) prevalence of HCV antibodies. The patients who were HCV antibody positive were more likely to be male, older, and insured by Medicaid (P < or = .02). Those who had risk factors within the medical, exposure, and social history domains were more likely to be HCV antibody positive. The area under the receiver operating characteristic curve for the screening tool based on these 3 domains was 0.77. With an increasing number of positive domains, there was a higher likelihood of HCV antibody positivity. Only 2% of patients with 0 risk factors had HCV antibodies.
A prediction tool can be used to accurately identify patients at high risk of HCV who may benefit from serologic screening. Future studies should assess whether wider use of this tool may lead to improved outcomes.
尽管丙型肝炎病毒（HCV）在全国的估计患病率为1.8%，但检测率低于指南推荐水平，尤其是在初级保健领域。关键步骤是能够识别出应接受筛查的高危患者。我们试图前瞻性地推导并验证一种临床预测工具，以协助初级保健提供者识别应进行HCV抗体检测的患者。
总共1000名随机选择的就诊于市中心初级保健诊所的患者填写了一份包含27个项目的问卷，评估5个HCV风险因素领域：工作、医疗、暴露、个人护理和社会史。之后，患者接受HCV抗体检测。进行多变量逻辑回归分析以识别与HCV抗体相关的风险因素。
HCV抗体患病率为8.3%（95%置信区间，6.7%-10.2%）。HCV抗体阳性的患者更可能为男性、年龄较大且由医疗补助计划承保（P≤0.02）。那些在医疗、暴露和社会史领域有风险因素的患者更可能HCV抗体阳性。基于这3个领域的筛查工具的受试者工作特征曲线下面积为0.77。随着阳性领域数量增加，HCV抗体阳性的可能性更高。0个风险因素的患者中只有2%有HCV抗体。
一种预测工具可用于准确识别可能从血清学筛查中受益的HCV高危患者。未来研究应评估更广泛使用该工具是否可能改善结果。
