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. 2019 Feb;37(2):286-290.
doi: 10.1016/j.ajem.2018.08.067. Epub 2018 Aug 29.

Advanced liver fibrosis and care continuum in emergency department patients with chronic hepatitis C

Yu-Hsiang Hsieh  1 , Danielle Signer  2 , Anuj V Patel  2 , Valentina Viertel  2 , Mustapha Saheed  2 , Risha Irvin  3 , Mark S Sulkowski  3 , David L Thomas  3 , Richard E Rothman  4
Affiliations

Advanced liver fibrosis and care continuum in emergency department patients with chronic hepatitis C

Yu-Hsiang Hsieh et al. Am J Emerg Med. 2019 Feb.

Abstract

Background: FIB-4, a non-invasive serum fibrosis index (which includes age, ALT, AST, and platelet count), is frequently available during ED visits. Our objective was to define 1-year HCV-related care outcomes of ED patients with known HCV, for the overall group, and both those with and without advanced fibrosis.

Methods: As part of an ongoing HCV linkage-to-care (LTC) program, HCV-infected ED patients were identified retrospectively via medical record review. Components of FIB-4 were abstracted, and patients with an FIB-4 > 3.25 were classified with advanced fibrosis and characterized with regards to downstream HCV care continuum outcomes at one-year after enrollment.

Results: Of the 113 patients with known HCV, 38 (33.6%) had advanced fibrosis. One-year outcomes along the HCV care continuum after ED encounter for 'all' 113, 75 'without advanced fibrosis', and 38 'advanced fibrosis' patients, respectively, were as follows: agreeing to be linked to care [106 (93.8%), 72 (96.0%), 34 (89.5%)]; LTC [38 (33.6%), 21 (28.0%), 17 (44.7%)]; treatment initiation among those linked [16 (42.1%), 9 (42.9%), 7 (41.2%)]; sustained virologic response 4 weeks post-treatment among those treated [15 (93.8%), 9 (100.0%), 6 (85.7%)]; documented all-cause mortality [10 (8.8%), 3 (4.0%), 7 (18.4%)]. Notably, 70% of those who died had advanced fibrosis. For those with advanced liver fibrosis, all-cause mortality was significantly higher, than those without (18.4% versus 4.0%, p = 0.030).

Conclusions: Over one-third of HCV-infected ED patients have advanced liver fibrosis, incomplete LTC, and higher mortality, suggesting this readily-available FIB-4 might be used to prioritize LTC services for those with advanced fibrosis.

Keywords: CDC recommendations; Emergency department; HCV; HCV testing; Undiagnosed infection.

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Conflict of interest statement

Declaration of interests

We declare no competing interests.

Figures

Figure 1:
Figure 1:. HCV Care Continuum in 113 Chronic HCV-Infected Emergency Department Patients by Advanced Liver Fibrosis Status Which Was Estimated by FIB-4 Index.
Footnote: 1 ED patient was excluded from the final analysis due to incomplete data, leaving n=113.
See this image and copyright information in PMC

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