Advanced liver fibrosis and care continuum in emergency department patients with chronic hepatitis C
Yu-Hsiang Hsieh1, Danielle Signer1, Anuj V Patel1
1Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Insights
The FIB-4 score can identify Hepatitis C Virus (HCV) patients in the ED with advanced liver fibrosis. Prioritizing linkage to care for these patients may improve outcomes and reduce mortality.
Area of Science:
- Hepatology
- Public Health
- Emergency Medicine
Background:
- Hepatitis C Virus (HCV) infection remains a significant public health concern.
- The FIB-4 index, a non-invasive marker, is readily available in emergency departments (EDs).
- Assessing advanced liver fibrosis in HCV-infected ED patients is crucial for timely intervention.
Purpose of the Study:
- To evaluate the 1-year Hepatitis C Virus (HCV)-related care outcomes for patients presenting to the ED with known HCV.
- To compare outcomes between patients with and without advanced liver fibrosis, identified using the FIB-4 index.
- To determine the utility of the FIB-4 index in stratifying risk and prioritizing care.
Main Methods:
- Retrospective review of medical records for HCV-infected ED patients enrolled in a linkage-to-care program.
- Calculation of the FIB-4 index using age, ALT, AST, and platelet count.
- Classification of advanced fibrosis using FIB-4 > 3.25 and tracking of HCV care continuum outcomes over one year.
Main Results:
- 33.6% of 113 HCV-infected ED patients had advanced fibrosis (FIB-4 > 3.25).
- Patients with advanced fibrosis exhibited significantly higher 1-year all-cause mortality (18.4% vs. 4.0%, p=0.030).
- Linkage to care and treatment initiation rates were suboptimal across both groups, with higher mortality in the advanced fibrosis cohort.
Conclusions:
- Over one-third of HCV-infected ED patients present with advanced liver fibrosis.
- The FIB-4 index is a valuable tool for identifying high-risk HCV patients in the ED.
- Prioritizing linkage to care services for HCV patients with advanced fibrosis identified by FIB-4 may improve outcomes and reduce mortality.
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.
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