Cirrhosis linked to 30% of chronic HBV patients at initial presentation

Issue: June 2017

CHICAGO — In a safety-net hospital system study, researchers found that nearly 30% of patients with chronic hepatitis B had cirrhosis at initial presentation, especially men, older patients and patients with non-alcoholic fatty liver disease, according to a presentation at Digestive Disease Week.

“Delays in diagnosis potentially may be more common in underserved-type populations where there are definitely issues with access to care that might contribute to more severe disease presentation,” Robert J. Wong, MD, MS, from the Alameda Health System of Highland Hospital, Oakland, California, said in a presentation. “The aim of our study was to evaluate rates and predictors of cirrhosis and cirrhosis-related complications among adults with chronic hepatitis B among ... a diverse county hospital system.”

The retrospective study comprised 329 patients with chronic HBV seen at gastroenterology clinics in a large community-based safety-net hospital system between July 2014 and May 2016. Mean patient age was 49.2 years, 55.1% were men and 66.5% were Asian. Additionally, 18.9% were e Antigen positive, 35.9% had NAFLD, 27.7% had cirrhosis at initial presentation, 4.3% had ascites, 3.7% had variceal bleeding, 3.9% had hepatic encephalopathy and 4% had hepatocellular carcinoma.

At initial presentation, men were more likely to have cirrhosis (34.6% vs. 19.1%; P < .01) and variceal bleeding (5.6% vs. 1.4%; P < .05) than women. Although not significant, patients with NAFLD demonstrated a minor trend toward higher rates of cirrhosis at initial presentation compared with patients without NAFLD (33.3% vs. 25%).

Further analysis confirmed that men (OR = 2.02; 95% CI, 1.19-3.43) and older patients (OR = 1.03; 95% CI, 1.01-1.06) were more likely to have cirrhosis at initial presentation.

Wong advised that key factors to be addressed in improving diagnosis and treatment of these populations include developing patient awareness and adherence to testing, as well as adherence to follow-up, system factors such as implementing electronic health record supportive mechanisms to reduce human error, and improving communication access to patients, many of whom may not have clear contact information in the health care system or are homeless.

“The importance of identifying these patients early, plugging them into care, assessing them, managing them, and then starting them on treatment if appropriate — that process is not as easy as it seems, especially in settings where resources are limited and patient education is limited,” Wong said. “The cascade relies on a very effective flow, where you identify risk groups, screen them ... get confirmatory testing if appropriate, and then those who are diagnosed with disease need to be linked to care. Not only do they need to be linked to care, they have to stay and be maintained in care for continued management of treatment.” – by Talitha Bennett

References:

Wong RJ. Abstract 741d. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.

Disclosure : Wong reports receiving speaking and teaching fees from Salix; grant and research support from Gilead; and receives advisory committee fees from Gilead Sciences.