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Am J Gastroenterol. 2015 Aug;110(8):1169-77; quiz 1178. doi: 10.1038/ajg.2015.203. Epub 2015 Jul 28.

Prevalence of cirrhosis in hepatitis C patients in the Chronic Hepatitis Cohort Study (CHeCS): a retrospective and prospective observational study.

Author information

1
Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA.
2
Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA.
3
Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA.
4
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
5
Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA.
6
Center for Health Research, Kaiser Permanente-Hawaii, Honolulu, Hawaii, USA.
7
Center For Health Research, Kaiser Permanente-Northwest, Portland, Oregon, USA.

Abstract

OBJECTIVES:

The severity of liver disease in the hepatitis C virus (HCV)-infected population in the United States remains uncertain. We estimated the prevalence of cirrhosis in adults with chronic hepatitis C (CHC) using multiple parameters including liver biopsy, diagnosis/procedure codes, and a biomarker.

METHODS:

Patients enrolled in the Chronic Hepatitis Cohort Study (CHeCS) who received health services during 2006-2010 were included. Cirrhosis was identified through liver biopsy reports, diagnosis/procedure codes for cirrhosis or hepatic decompensation, and Fibrosis-4 (FIB-4) scores ≥5.88. Demographic and clinical characteristics associated with cirrhosis were identified through multivariable logistic modeling.

RESULTS:

Among 9,783 patients, 2,788 (28.5%) were cirrhotic by at least one method. Biopsy identified cirrhosis in only 661 (7%) patients, whereas FIB-4 scores and diagnosis/procedure codes for cirrhosis and hepatic decompensation identified cirrhosis in 2,194 (22%), 557 (6%), and 482 (5%) patients, respectively. Among 661 patients with biopsy-confirmed cirrhosis, only 356 (54%) had an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for cirrhosis. Older age, male gender, Asian race, Hispanic ethnicity, genotype 3 infection, HIV coinfection, diabetes, history of antiviral therapy, and history of alcohol abuse were independently associated with higher odds of cirrhosis (all, P<0.05). Conversely, private health insurance coverage, black race, and HCV genotype 2 were associated with lower odds of cirrhosis.

CONCLUSIONS:

A high proportion of patients with biopsy-confirmed cirrhosis are not assigned ICD-9 codes for cirrhosis. Consequently, ICD-9 codes may not be reliable as the sole indicator of the prevalence of cirrhosis in cohort studies. Use of additional parameters suggests a fourfold higher prevalence of cirrhosis than is revealed by biopsy alone. These findings suggest that cirrhosis in CHC patients may be significantly underdocumented and underdiagnosed.

PMID:
26215529
PMCID:
PMC5731242
DOI:
10.1038/ajg.2015.203
[Indexed for MEDLINE]
Free PMC Article

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