The number of Hepatitis C patients suffering from advanced liver damage may be grossly underestimated and underdiagnosed, according to a new study led by researchers at Henry Ford Health System and the Centers for Disease Control and Prevention.
The findings, which were published in The American Journal of Gastroenterology (110, 1169-1177, August 2015), were the result of a study of nearly 10,000 patients suffering from Hepatitis C.
“Knowledge of the prevalence of liver damage will help decision making regarding screening for the effects of Hepatitis C, when to start anti-viral therapy, and the need for follow-up counseling,” said lead researcher Stuart Gordon, MD, director of Hepatology at Henry Ford Hospital in Deroit.
The Chronic Hepatitis Cohort Study is an analysis of records from a large, geographically and racially diverse group of 9,783 patients receiving care at four large U.S. health systems. The records analyzed by researchers indicated evidence of cirrhosis in 29 percent, or 2,788, of the Hepatitis C patients included in the study. Surprisingly, however, 1,727 of those 2,788 patients, or 62 percent, had no formal documentation in their medical records that they had cirrhosis.
Gordon said the results suggest cirrhosis may be underdiagnosed in a large segment of the population. Clinicians, he continued, typically rely on liver biopsies to diagnose cirrhosis, but in the Hepatitis C patients studied, only 661 patients were diagnosed with cirrhosis through a liver biopsy.
“Our results suggest a fourfold higher prevalence of cirrhosis than is indicated by biopsy alone,” said Gordon.
The researchers discovered highly likely signs of liver damage by calculating the patients’ liver enzymes, platelet counts and age in a previously validated test called a FIB-4 score.
“It’s an underappreciated, easily obtained, and widely available test done through lab work that can point out there’s a problem,” noted Gordon. “It’s a simple test not routinely used by clinicians. A lot of patients in our study had cirrhosis and probably didn’t know they had cirrhosis. In addition, electronic medical record reports may not be a reliable indicator of just how many Hepatitis C patients may be suffering from cirrhosis.”
The results of such testing and reporting could have wide impact on the treatment of those with Hepatitis C, which is now curable in many cases with oral antivirals.
“People with Hepatitis C need to find out the severity of their underlying liver disease because they may not realize that they have cirrhosis,” said Gordon. “Obviously, treatment can slow down the progression.”
WEB:
American Journal of Gastroenterology Article: http://www.nature.com/ajg/journal/v110/n8/full/ajg2015203a.html