Yeo Yee Hui, Hwang Jungyun, Jeong Donghak, Dang Nolan, Kam Leslie Y, Henry Linda, Park Haesuk, Cheung Ramsey, Nguyen Mindie H
Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States; Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States.
Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States.
J Hepatol. 2021 Oct;75(4):856-864. doi: 10.1016/j.jhep.2021.04.042. Epub 2021 May 7.
BACKGROUND & AIMS: Regular monitoring/surveillance for liver complications is crucial to reduce morbidity and mortality in patients with cirrhosis. Recommendations from professional societies are available but adherence is not well studied, especially outside of academic centers. We aimed to determine the frequencies and factors associated with laboratory monitoring, and hepatocellular carcinoma (HCC) and esophageal varices (EV) surveillance in patients with cirrhosis.
We identified 82,427 patients with cirrhosis (43,280 compensated and 39,147 decompensated) from the Truven Health MarketScan Research Database®, 2007-2016. We calculated the proportion of patients with cirrhosis with various frequencies of procedures/testing: laboratory (complete blood count, comprehensive metabolic panel, and prothrombin time), HCC and EV surveillance. We also used multivariable logistic regression to determine factors associated with having procedures.
The proportions of patients undergoing HCC surveillance (8.78%), laboratory testing (29.72%) at least every 6-12 months, or EV surveillance (10.6%) at least every 1-2 years were suboptimal. The majority did not have HCC (45.4%) or EV (80.3%) surveillance during the entire study period. On multivariable regression, age 41-55 (vs. <41) years, preferred provider organization (vs. health maintenance organization) insurance plan, specialist care (vs. primary care and other specialties), diagnosis between 2013-2016 (vs. 2007-2009), decompensated (vs. compensated) cirrhosis, non-alcoholic fatty liver disease (vs. viral hepatitis), and higher Charlson comorbidity index were associated with significantly higher odds of undergoing procedures/testing every 6-12 months and EV surveillance every 1-2 years.
Despite modest improvements in more recent years, routine monitoring and surveillance for patients with cirrhosis is suboptimal. Further efforts including provider awareness, patient education, and system/incentive-based quality improvement measures are urgently needed.
Patients with cirrhosis should undergo health monitoring for liver complications to achieve early detection and treatment. In a large nationwide cohort of 82,427 patients with cirrhosis in the United States, we found a low rate of adherence (well less than half) to routine blood test monitoring and surveillance for liver cancer and esophageal varices (swollen blood vessels in the abdomen that could lead to fatal bleeding). Adherence has increased in the recent years, but much more improvement is needed.
定期监测/筛查肝脏并发症对于降低肝硬化患者的发病率和死亡率至关重要。专业学会已给出相关建议，但对其依从性的研究尚不充分，尤其是在学术中心以外的地区。我们旨在确定肝硬化患者进行实验室监测、肝细胞癌（HCC）和食管静脉曲张（EV）筛查的频率及相关因素。
我们从Truven Health MarketScan Research Database®（2007 - 2016年）中识别出82427例肝硬化患者（43280例代偿期和39147例失代偿期）。我们计算了不同检查/检测频率的肝硬化患者比例：实验室检查（全血细胞计数、综合代谢指标和凝血酶原时间）、HCC和EV筛查。我们还使用多变量逻辑回归来确定与进行这些检查相关的因素。
HCC筛查（8.78%）、至少每6 - 12个月进行一次实验室检查（29.72%）或至少每1 - 2年进行一次EV筛查（10.6%）的患者比例并不理想。在整个研究期间，大多数患者未进行HCC（45.4%）或EV（80.3%）筛查。在多变量回归分析中，年龄41 - 55岁（与<41岁相比）、首选医疗机构（与健康维护组织相比）保险计划、专科护理（与初级护理和其他专科相比）、2013 - 2016年诊断（与2007 - 2009年相比）、失代偿期（与代偿期相比）肝硬化、非酒精性脂肪性肝病（与病毒性肝炎相比）以及更高的Charlson合并症指数与每6 - 个月进行一次检查/检测以及每1 - 2年进行一次EV筛查的几率显著升高相关。
尽管近年来有一定改善，但肝硬化患者的常规监测和筛查仍不理想。迫切需要进一步努力，包括提高医疗服务提供者的意识、对患者进行教育以及采取基于系统/激励措施的质量改进措施。
肝硬化患者应接受肝脏并发症的健康监测以实现早期发现和治疗。在美国一个包含82427例肝硬化患者的大型全国性队列中，我们发现对常规血液检查监测以及肝癌和食管静脉曲张（腹部可能导致致命出血的血管肿胀）筛查的依从率较低（远低于一半）。近年来依从率有所提高，但仍需更大幅度的改善。
