Lapointe-Shaw Lauren, Chung Hannah, Sander Beate, Kwong Jeffrey C, Holder Laura, Cerocchi Orlando, Austin Peter C, Feld Jordan J
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Liver Int. 2021 Jan;41(1):33-47. doi: 10.1111/liv.14670.
BACKGROUND & AIMS: Hepatitis C virus (HCV) is a common and treatable cause of cirrhosis and its complications, yet many chronically infected individuals remain undiagnosed until a late stage. We sought to identify the frequency of and risk factors for HCV diagnosis peri-complication, that is within six months of an advanced liver disease complication.
This was a retrospective cohort study of Ontario residents diagnosed with chronic HCV infection between 2003 and 2014. HCV diagnosis peri-complication was defined as the occurrence of decompensated cirrhosis, hepatocellular carcinoma or liver transplant within ±6 months of HCV diagnosis. Multivariable logistic regression was used to identify risk factors for peri-complication diagnosis among all those diagnosed with HCV infection.
Our cohort included 39,515 patients with chronic HCV infection, of whom 4.2% (n = 1645) were diagnosed peri-complication; these represented 31.6% of the 5,202 patients who developed complications in the follow-up period. Peri-complication diagnosis became more common over the study period and was associated with increasing age among baby boomers, alcohol use, diabetes mellitus, chronic HBV co-infection and moderate to high levels of morbidity. Female sex, immigrant status, having more previous outpatient physician visits, a previous emergency department visit, a history of drug use or mental health visits were associated with reduced risk of peri-complication diagnosis.
Over a quarter of HCV-infected patients with complications were diagnosed peri-complication. This problem increased over time, suggesting a need to further expand HCV screening.
丙型肝炎病毒（HCV）是肝硬化及其并发症常见且可治疗的病因，但许多慢性感染者直到晚期才被诊断出来。我们试图确定HCV诊断在并发症发生期间（即晚期肝病并发症发生后的六个月内）的频率及危险因素。
这是一项对2003年至2014年间被诊断为慢性HCV感染的安大略省居民进行的回顾性队列研究。HCV诊断在并发症发生期间被定义为在HCV诊断前后±6个月内出现失代偿性肝硬化、肝细胞癌或肝移植。多变量逻辑回归用于确定所有被诊断为HCV感染的患者中并发症发生期间诊断的危险因素。
我们的队列包括39,515例慢性HCV感染患者，其中4.2%（n = 1645）在并发症发生期间被诊断；这些患者占随访期间发生并发症的5202例患者的31.6%。在研究期间，并发症发生期间的诊断变得更加常见，并且与婴儿潮一代年龄增加、饮酒、糖尿病、慢性HBV合并感染以及中度至高度发病率相关。女性、移民身份、以前门诊就诊次数较多、以前去过急诊科、有吸毒史或心理健康就诊史与并发症发生期间诊断的风险降低相关。
超过四分之一的HCV感染并发症患者在并发症发生期间被诊断。这个问题随着时间的推移而增加，表明需要进一步扩大HCV筛查。
