Hepatitis C Testing and Liver Fibrosis Predictors in the Birth Cohort of a Primary Care Practice

Sophie Bersoux; Lanyu Mi; Bashar A Aqel; Rolland C Dickson

doi:10.1016/j.mayocpiqo.2020.04.003

Hepatitis C Testing and Liver Fibrosis Predictors in the Birth Cohort of a Primary Care Practice

Mayo Clin Proc Innov Qual Outcomes. 2020 Jul 15;4(4):384-390. doi: 10.1016/j.mayocpiqo.2020.04.003. eCollection 2020 Aug.

Authors

Sophie Bersoux¹, Lanyu Mi², Bashar A Aqel³, Rolland C Dickson³

Affiliations

¹ Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ.
² Division of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, AZ.
³ Division of Gastroenterology and Hepatology, Mayo Clinic Hospital, Phoenix, AZ.

Abstract

Objective: To determine the prevalence of and risk factors for advanced fibrosis in patients born from 1945 through 1965 (birth cohort) who underwent testing for hepatitis C virus (HCV).

Patients and methods: Data were extracted from the electronic health record of all patients receiving primary care at a single academic institution who underwent HCV testing between September 8, 2010, and March 5, 2018. The birth cohort patients were the primary focus of the study. Fibrosis 4 (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) scores were calculated to screen for fibrosis.

Results: During the study period, 7097 birth cohort patients had HCV antibody testing, 3462 (48.8%) of whom were men, 6435 (91.0%) were white, 1028 (14.5%) had diabetes mellitus, 2,034 (36.5%) had an alanine aminotransferase (ALT) level greater than 30 U/L, and 2,396 (34.2%) had body mass index of 30 kg/m² or greater. Hepatitis C virus antibody was present in 124 (1.7%), 33 (26.6%) of whom had HCV viremia. Estimated prevalence of METAVIR [Meta-analysis of Histological Data in Viral Hepatitis] stage 4 fibrosis was 4.1% (180 of 4433) by a FIB-4 score of 3.25 or greater and 4.3% (204 of 4763) by an APRI score greater than 1.0. The odds ratio (OR) for fibrosis, determined by APRI, was significant for HCV RNA positivity (OR, 15.98; 95% CI, 7.23-35.32; P<.001), diabetes mellitus (OR, 1.98; 95% CI, 1.40-2.79; P<.001), and ALT value greater than 30 U/L (OR, 15.07 U/L; 95% CI, 9.27-24.52 U/L; P<.001) but not for body mass index of 30 kg/m² or greater (OR, 0.77; 95% CI, 0.56-1.06; P=.11).

Conclusion: Hepatitis C virus viremia, diabetes mellitus, and elevated ALT levels were associated with increased odds for development of fibrosis. In addition to HCV testing, diabetes mellitus and elevated ALT level are potential parameters to use for recommending noninvasive testing for fibrosis.

Keywords: ALT, alanine aminotransferase; APRI, aspartate aminotransferase to platelet ratio index; AST, aspartate aminotransferase; BMI, body mass index; CDC, Centers for Disease Control and Prevention; EHR, electronic health record; FIB-4, fibrosis 4; HCV, hepatitis C virus; METAVIR, Meta-analysis of Histological Data in Viral Hepatitis; NASH, nonalcoholic steatohepatitis; OR, odds ratio; USPSTF, United States Preventive Services Task Force.