Liver biopsy performance and histological findings among patients with chronic viral hepatitis: a Danish database...

Area of Science:

• Hepatology
• Virology
• Public Health

Background:

• Chronic viral hepatitis, including hepatitis B (HBV) and hepatitis C (HCV), remains a significant global health concern.
• Liver biopsy is a key diagnostic tool for assessing fibrosis and guiding treatment decisions in viral hepatitis.
• Variations in clinical practice and patient demographics can influence disease management and outcomes.

Purpose of the Study:

• To investigate the variability in liver biopsy frequency and histological findings among patients with chronic viral hepatitis across multiple medical centers in Denmark.
• To identify demographic and clinical factors associated with the development of significant liver fibrosis and cirrhosis.

Main Methods:

• A retrospective analysis of patients with chronic viral hepatitis (positive for HBsAg or HCV-RNA) was conducted using the national clinical database (DANHEP).
• Data collected included patient demographics, laboratory results (including alanine-aminotransferase levels), and liver biopsy findings classified using the Metavir system.
• Statistical analysis was performed to determine factors associated with liver biopsy outcomes and cirrhosis.

Main Results:

• A total of 1586 patients were included: 69.7% had hepatitis C, 28.9% hepatitis B, and 1.5% were coinfected.
• Liver biopsy was performed in 48.6% of patients, with significant center-to-center variation (33.3-78.7%).
• Septal fibrosis (≥F2) was observed in 29.3% and cirrhosis (F4) in 13.9% of biopsied patients. Cirrhosis prevalence ranged from 8.3% to 18.6% across centers and was independently associated with older age, male gender, elevated ALT, and non-Danish origin. Among hepatitis C patients with known infection duration, 23% developed cirrhosis after 20 years. Age over 40 was a stronger predictor of cirrhosis than elevated ALT.

Conclusions:

• Significant variations exist in liver biopsy utilization and the prevalence of advanced fibrosis/cirrhosis among chronic viral hepatitis patients in Denmark.
• Patient factors such as age, gender, ethnicity, and viral hepatitis type influence the risk of developing cirrhosis.
• National database comparisons are valuable for identifying disparities and informing strategies for improved management of chronic viral hepatitis.