Lapointe-Shaw Lauren, Chung Hannah, Holder Laura, Kwong Jeffrey C, Sander Beate, Austin Peter C, Janssen Harry L A, Feld Jordan J
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Toronto General Hospital Research Institute, Toronto, ON, Canada.
Hepatology. 2021 Jun;73(6):2141-2154. doi: 10.1002/hep.31557. Epub 2021 Jun 15.
Hepatitis B virus (HBV) is a major cause of chronic liver disease, which can progress to cirrhosis, hepatocellular carcinoma, and death. A timely diagnosis allows for antiviral treatment, which can prevent liver-related complications. Conversely, a late diagnosis signals a missed opportunity for earlier care and treatment. Our objective was to measure the proportion of chronic HBV diagnoses that are made within 6 months of presentation with a liver disease-related complication and examine associated factors and trends over time.
We used provincial laboratory data to identify patients with chronic HBV diagnosed from 2003 to 2014. We measured the proportion who experienced a liver disease complication (decompensated cirrhosis, hepatocellular carcinoma, or liver transplant) within ±6 months of their HBV diagnosis date. A multivariable logistic regression model was used to identify factors associated with HBV diagnosis pericomplication. Of 18,434 patients with chronic HBV, 1,279 (6.9%) developed an HBV-related complication during the follow-up period. Among these, 570 (44.6%) had a first diagnosis pericomplication. HBV diagnosis pericomplication did not decrease over time and was independently associated with older age at HBV diagnosis, rural residence, alcohol use, and moderate to high levels of comorbidity. Female patients, immigrants, and those with more outpatient physician visits were less likely to have an HBV diagnosis pericomplication.
A high proportion of patients with HBV-related complications are first diagnosed with HBV pericomplication. These signal missed opportunities for earlier detection and treatment. Our findings support expansion of HBV screening.
乙型肝炎病毒（HBV）是慢性肝病的主要病因，可进展为肝硬化、肝细胞癌并导致死亡。及时诊断可进行抗病毒治疗，从而预防肝脏相关并发症。相反，延迟诊断意味着错失早期治疗的机会。我们的目标是衡量在出现肝脏疾病相关并发症的6个月内确诊慢性HBV的比例，并研究相关因素及随时间的变化趋势。
我们利用省级实验室数据，确定2003年至2014年期间确诊的慢性HBV患者。我们衡量了在其HBV诊断日期前后6个月内发生肝脏疾病并发症（失代偿期肝硬化、肝细胞癌或肝移植）的患者比例。采用多变量逻辑回归模型确定与并发症期间HBV诊断相关的因素。在18434例慢性HBV患者中，1279例（6.9%）在随访期间出现HBV相关并发症。其中，570例（44.6%）首次在并发症期间被诊断。并发症期间的HBV诊断率并未随时间下降，且与HBV诊断时年龄较大、农村居住、饮酒以及中度至高度合并症独立相关。女性患者、移民以及门诊就诊次数较多的患者在并发症期间被诊断为HBV的可能性较小。
很大一部分HBV相关并发症患者首次在并发症期间被诊断为HBV。这些表明错失了早期检测和治疗的机会。我们的研究结果支持扩大HBV筛查。
