Prince David S, Hoque Shakira, Kim Christy, Maher Salim, Miller Jane, Chomley Phoebe, Pritchard-Jones Janice, Spruce Sally, McGarry Nathan, Baker David, Elix Penelope, Liu Ken, Strasser Simone I, Goodger Brendan, Zekry Amany, McCaughan Geoffrey W
AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Liver Injury and Cancer Program, Centenary Institute, Sydney, New South Wales, Australia.
J Gastroenterol Hepatol. 2025 Jan;40(1):250-257. doi: 10.1111/jgh.16782. Epub 2024 Oct 24.
Most patients with cirrhosis have compensated disease and are cared for in primary care; however, the exact epidemiology within Australia remains largely unknown. The aim of this study was to assess cirrhosis care in an Australian primary care setting by evaluating rates of cirrhosis diagnosis, appropriate hepatocellular carcinoma (HCC) surveillance and specialist communication.
Electronic medical records in consenting general practices were reviewed using the "Liver Toolkit" to identify patients with an existing cirrhosis diagnosis. Individual cases were reviewed to identify outcomes of interest.
One hundred seventy-one patients with confirmed cirrhosis across nine general practices were identified (74% male, mean age: 61.2 years). There was significant variation in the rate of cirrhosis diagnosis between practices (range 31.7-637.9 per 100 000 patients, P < 0.0001). Patients with cirrhosis had predominately compensated disease (75% Child-Pugh A) and common etiologies of cirrhosis were alcohol (49%), hepatitis C (47%), and metabolic dysfunction-associated steatotic liver disease (29%). Forty-two patients (25%) had received appropriate HCC surveillance. Predictors of inadequate HCC surveillance were time from last specialist correspondence (odds ratio [OR] = 1.06 per month increase, 95% confidence interval [CI]: 1.02-1.10, P = 0.002) and hepatitis B (OR = 0.24, 95% CI: 0.06-0.98, P = 0.047). Specialist correspondence with primary care was older than 2 years or absent in 37% of cases.
There was a 20-fold difference in the rate of cirrhosis diagnosis between general practices within Sydney, suggesting a large proportion of patients remain undiagnosed. Three quarters of patients with diagnosed cirrhosis are not receiving appropriate HCC surveillance.
大多数肝硬化患者病情处于代偿期，由初级保健机构负责照料；然而，澳大利亚国内确切的流行病学情况仍大多未知。本研究旨在通过评估肝硬化诊断率、适当的肝细胞癌（HCC）监测情况以及专科医生沟通情况，来评估澳大利亚初级保健机构中对肝硬化的照护情况。
使用“肝脏工具包”对同意参与研究的全科医疗诊所的电子病历进行审查，以确定已确诊肝硬化的患者。对个体病例进行审查以确定感兴趣的结果。
在9家全科医疗诊所中识别出171例确诊肝硬化患者（男性占74%，平均年龄：61.2岁）。各诊所之间肝硬化诊断率存在显著差异（范围为每10万名患者31.7 - 637.9例，P < 0.0001）。肝硬化患者大多病情处于代偿期（75%为Child-Pugh A级），肝硬化的常见病因是酒精（49%）、丙型肝炎（47%）和代谢功能障碍相关脂肪性肝病（29%）。42例患者（25%）接受了适当的HCC监测。HCC监测不足的预测因素为距上次专科医生通信的时间（比值比[OR] = 每月增加1.06，95%置信区间[CI]：1.02 - 1.10，P = 0.002）和乙型肝炎（OR = 0.24，95% CI：0.06 - 0.98，P = 0.047）。专科医生与初级保健机构的通信超过2年或在37%的病例中不存在。
悉尼各全科医疗诊所之间肝硬化诊断率相差20倍，这表明很大一部分患者仍未被诊断出来。四分之三已确诊肝硬化的患者未接受适当的HCC监测。
