Low-Barrier Fibrosis Screening in Hepatitis C Treatment: The Decompensated Cirrhosis in Hepatitis C Evaluation...

Achieving hepatitis C virus (HCV) elimination requires innovative paradigms that overcome barriers to treatment, such as requiring pre-treatment elastography or phlebotomy-based fibrosis assessment. To identify patients at low risk of advanced fibrosis or decompensated cirrhosis within our HCV treatment programme, we developed and retrospectively assessed a clinical decision tool, the Decompensated Cirrhosis in Hepatitis C Evaluation Questionnaire (DCHEQ). Here we describe the development of DCHEQ and its test characteristics. We conducted a retrospective, nested, case-control study within a cohort of 1743 patients with HCV enrolled in an urban HCV elimination programme. The primary analysis defined cases of decompensated cirrhosis by chart review. A secondary analysis defined cases of advanced fibrosis as those with aspartate aminotransferase (AST)-platelet ratio index (APRI) > 1.5. The primary outcome was the area under the receiver operator curve (AUC) of the total DCHEQ to predict decompensated cirrhosis. We also compared the AUC of the total DCHEQ to the AUC of components of the DHEQ. For detecting cases of decompensated cirrhosis, the total of all DCHEQ items resulted in a mean AUC = 0.991 (95% CI = 0.963-1.000), which was significantly better than the discrimination of any alternative combination of DCHEQ items (p < 0.00001). For detecting cases of advanced fibrosis, the total DCHEQ score resulted in a mean AUC = 0.921 (95% CI = 0.871-0.966), which was superior to all other DCHEQ item combinations (p < 0.02). DCHEQ exhibited exquisite discrimination between cases of both decompensated cirrhosis and advanced fibrosis versus controls. After prospective validation, DCHEQ could be included in test-and-treat HCV treatment paradigms.