Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
Dig Dis Sci. 2024 Oct;69(10):3721-3728. doi: 10.1007/s10620-024-08601-8. Epub 2024 Sep 20.
Chronic liver diseases (CLD), cirrhosis, and hepatocellular carcinoma (HCC) cause significant morbidity and mortality. Unfortunately, patients with CLD often go undiagnosed until progression to cirrhosis and HCC. We aimed to determine the proportion of primary care patients with severe liver disease outcomes that had missed or delayed CLD diagnoses.
This retrospective cohort study evaluated primary care patients with a diagnosis of cirrhosis, HCC, or other severe liver disease outcome between 2012 and 2021. The outcomes of interest were missed and delayed diagnoses of CLD, defined as the absence of a CLD diagnosis (missed) or first appearance of CLD on the same day as the cirrhosis diagnosis (delayed). Univariate analyses were performed to describe the cohort. Multivariable logistic regression models analyzed the association of aminotransferase elevations with the outcomes of interest.
Of 667 patients with cirrhosis or HCC, 133 (20%) had a missed CLD diagnosis, and 243 (36%) had a delayed CLD diagnosis. Alcohol-related liver disease was the most common etiology among patients with missed/delayed diagnoses. A lower proportion of patients with missed/delayed diagnoses had an elevation in ALT or AST compared to patients with timely diagnoses (61% vs. 77%, p < 0.001). Elevated aminotransferase values were associated with lower odds of a missed/delayed diagnosis (OR 0.47; 95%CI 0.34-0.66).
Most patients with cirrhosis or HCC had missed or delayed diagnoses of CLD in the context of probable overreliance on aminotransferase elevation for CLD detection. Enhanced screening for high prevalence CLD, especially alcohol, in primary care is needed.
慢性肝病 (CLD)、肝硬化和肝细胞癌 (HCC) 会导致严重的发病率和死亡率。不幸的是，CLD 患者常常在进展为肝硬化和 HCC 之前未被诊断出来。我们旨在确定患有严重肝病结局的初级保健患者中错过或延迟 CLD 诊断的比例。
这项回顾性队列研究评估了 2012 年至 2021 年间患有肝硬化、HCC 或其他严重肝病结局的初级保健患者。感兴趣的结局是错过和延迟的 CLD 诊断，定义为缺乏 CLD 诊断（错过）或 CLD 首次出现在肝硬化诊断的同一天（延迟）。进行了单变量分析以描述队列。多变量逻辑回归模型分析了氨基转移酶升高与感兴趣结局的关联。
在 667 名患有肝硬化或 HCC 的患者中，有 133 名（20%）存在 CLD 漏诊，243 名（36%）存在 CLD 延迟诊断。酒精相关肝病是错过/延迟诊断患者最常见的病因。与及时诊断的患者相比，错过/延迟诊断患者的 ALT 或 AST 升高比例较低（61%比 77%，p<0.001）。氨基转移酶升高值与错过/延迟诊断的可能性较低相关（OR 0.47；95%CI 0.34-0.66）。
在可能过度依赖氨基转移酶升高来检测 CLD 的情况下，大多数患有肝硬化或 HCC 的患者存在 CLD 的漏诊或延迟诊断。需要在初级保健中加强对高患病率 CLD（尤其是酒精）的筛查。
