Rodríguez-Tajes Sergio, Pocurull Anna, Castillo Joaquín, Casanova Gherzon, Vega Laia, Lens Sabela, Mariño Zoe, Londoño María-Carlota, Forner Alejandro, Torres Ferran, Forns Xavier
Liver Unit, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
Liver Unit, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain.
J Hepatol. 2020 Dec;73(6):1360-1367. doi: 10.1016/j.jhep.2020.07.018. Epub 2020 Jul 19.
BACKGROUND & AIMS: Complications of cirrhosis are the main cause of hospital admissions in liver units. In areas where HCV is prevalent, most of these admissions are attributable to HCV-related cirrhosis (HCV-cirrhosis). This study assessed the impact of direct-acting antivirals (DAA) in the profile of patients with liver disease admitted to a referral liver unit from a university hospital.
We registered hospital admissions resulting from cirrhosis to the Liver Unit of the Hospital Clinic of Barcelona, from 2011 to 2014 (pre-DAA period) and from 2015 to 2019 (post-DAA period).
From a total of 14,865 hospital admissions, 10,053 resulted from cirrhosis (corresponding to 6,272 patients). The number and proportion of hospital admissions because of HCV-cirrhosis remained stable during the period 2011-2014 (525 per year, 48.8% of the total), but decreased progressively after 2015 (p <0.001), reaching <300 (27.1%) admissions in 2019. Similarly, HCV-cirrhosis accounted for 3,885 inpatient days per year (44.9%) during the pre-DAA period and decreased steadily after 2015 (p >0.001), reaching only 1,909 inpatient days (22%) in 2019. The figures for intensive care unit admissions followed a similar pattern. By means of a slope analysis (binomial regression model), we predicted that HCV-cirrhosis hospital admissions will be residual by 2025 (2.3%, 95% CI 0-10.9%). By contrast, we observed a significant increase in hospital admissions because of metabolic-associated fatty liver disease (5-fold) and autoimmune hepatitis (4-fold) during the study period.
In summary, our data showed a profound reduction in HCV-cirrhosis hospitalisation burden since 2015, coincident with the wide use of DAAs in Spain. Our predictions suggest that, by 2025, HCV-cirrhosis will be a marginal cause of hospital admissions for patients with liver disease.
Over the past few years, the wide use of antiviral drugs that cure HCV has had a significant effect on patients being admitted to hospital. Most patients with HCV and cirrhosis are treated (and often cured) in the community and, thus, the number of hospital admissions because of severe forms of HCV has decreased drastically. HCV is no longer the first cause of admission into liver units and, in only a few years from now, it is likely to be only a residual cause of hospitalisation.
肝硬化并发症是肝病科住院的主要原因。在丙型肝炎病毒（HCV）流行的地区，这些住院病例大多归因于HCV相关肝硬化（HCV肝硬化）。本研究评估了直接抗病毒药物（DAA）对一所大学医院肝病转诊科收治的肝病患者情况的影响。
我们记录了2011年至2014年（DAA治疗前时期）以及2015年至2019年（DAA治疗后时期）巴塞罗那医院诊所肝病科因肝硬化导致的住院病例。
在总共14865例住院病例中，10053例由肝硬化导致（对应6272名患者）。2011 - 2014年期间，因HCV肝硬化导致的住院病例数量和比例保持稳定（每年525例，占总数的48.8%），但在2015年后逐渐下降（p <0.001），2019年降至<300例（27.1%）。同样，在DAA治疗前时期，HCV肝硬化每年占3885个住院日（44.9%），2015年后稳步下降（p >0.001），2019年仅为1909个住院日（22%）。重症监护病房收治病例数也呈现类似模式。通过斜率分析（二项回归模型），我们预测到2025年，因HCV肝硬化导致的住院病例将所剩无几（2.3%，95%置信区间0 - 10.9%）。相比之下，在研究期间，我们观察到因代谢相关脂肪性肝病导致的住院病例显著增加（5倍），自身免疫性肝炎导致的住院病例增加（4倍）。
总之，我们的数据显示自2015年以来，HCV肝硬化住院负担大幅降低，这与DAA在西班牙的广泛使用相吻合。我们的预测表明，到2025年，HCV肝硬化将成为肝病患者住院的次要原因。
在过去几年中，广泛使用的治愈HCV的抗病毒药物对住院患者产生了重大影响。大多数HCV和肝硬化患者在社区接受治疗（且常被治愈），因此，因严重HCV形式导致的住院病例数量急剧下降。HCV不再是肝病科住院的首要原因，并且从现在起再过几年，它可能仅成为住院的次要原因。
