Format

Send to

Choose Destination
BMC Med. 2017 May 3;15(1):92. doi: 10.1186/s12916-017-0856-y.

Late presentation of chronic viral hepatitis for medical care: a consensus definition.

Author information

1
Center for HIV and Hepatogastroenterology, Humboldtstrasse 18, 40237, Düsseldorf, Germany.
2
European Association for the Study of the Liver (EASL), 7rue Daubin, 1203, Geneva, Switzerland.
3
Liver Department, Cochin Hospital, 27, rue du Faubourg-Saint-Jacques, 75014, Paris, France.
4
Liver Unit Hospital Universitari Vall d'Hebron and Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Hepáticas y Digestivas (CIBERehd)del Instituto Carlos III Barcelona, Paseo Valle Hebron 127, Barcelona, 08035, Spain.
5
European Centre for Disease Prevention and Control (ECDC), Granits väg 8, 171 65, Solna, Sweden.
6
Hepatitis C Trust, World Hepatitis Alliance, 27 Crosby Row, London, SE1 3YD, UK.
7
CHIP, Department of Infectious Diseases Section 2100, Rigshospitalet, University of Copenhagen, Finsencentret, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
8
European Liver Patients Association (ELPA), Rue de la Loi 235/27, 1040, Brussels, Belgium.
9
World Health Organization (WHO) Regional Office for Europe, UN City Marmorvej 51, DK-2100, Copenhagen, Denmark.
10
CHIP, Department of Infectious Diseases Section 2100, Rigshospitalet, University of Copenhagen, Finsencentret, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. dorthe.raben@regionh.dk.
11
HIV in Europe, Section 2100, Finsencentret Blegdamsvej 9, DK-2100, Copenhagen, Denmark. dorthe.raben@regionh.dk.
12
Foundation De Regenboog Groep (FRG) representing Correlation Network, Hepatitis C Initiative, Postbus 10887, 1001 EW, Amsterdam, The Netherlands.
13
Global Hepatitis Programme, World Health Organization (WHO), Geneva, Switzerland.
14
HIV in Europe, Section 2100, Finsencentret Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
15
Department of Medicine I, University of Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany.

Abstract

INTRODUCTION:

We present two consensus definitions of advanced and late stage liver disease being used as epidemiological tools. These definitions can be applied to assess the morbidity caused by liver diseases in different health care systems. We focus is on hepatitis B and C virus infections, because effective and well tolerated treatments for both of these infections have greatly improved our ability to successfully treat and prevent advanced and late stage disease, especially if diagnosed early. A consensus definition of late presentation with viral hepatitis is important to create a homogenous, easy-to-use reference for public health authorities in Europe and elsewhere to better assess the clinical situation on a population basis.

METHODS:

A working group including viral hepatitis experts from the European Association for the Study of the Liver, experts from the HIV in Europe Initiative, and relevant stakeholders including patient advocacy groups, health policy-makers, international health organisations and surveillance experts, met in 2014 and 2015 to develop a draft consensus definition of late presentation with viral hepatitis for medical care. This was refined through subsequent consultations among the group.

RESULTS:

Two definitions were agreed upon. Presentation with advanced liver disease caused by chronic viral hepatitis for medical care is defined as a patient with chronic hepatitis B and C and significant fibrosis (≥ F3 assessed by either APRI score > 1.5, FIB-4 > 3.25, Fibrotest > 0.59 or alternatively transient elastography (FibroScan) > 9.5 kPa or liver biopsy ≥ METAVIR stage F3) with no previous antiviral treatment. Late stage liver disease caused by chronic viral hepatitis is clinically defined by the presence of decompensated cirrhosis (at least one symptom of the following: jaundice, hepatic encephalopathy, clinically detectable ascites, variceal bleeding) and/or hepatocellular carcinoma.

CONCLUSION:

These consensus definitions will help to improve epidemiological understanding of viral hepatitis and possibly other liver diseases, as well as testing policies and strategies.

KEYWORDS:

Late presentation; Testing; Viral hepatitis

PMID:
28464883
PMCID:
PMC5414225
DOI:
10.1186/s12916-017-0856-y
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center