Yu-Hsiang Hsieh1, Danielle Signer2, Anuj V Patel2, Valentina Viertel2, Mustapha Saheed2, Risha Irvin3, Mark S Sulkowski3, David L Thomas3, Richard E Rothman4. 1. Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: yhsieh1@jhmi.edu. 2. Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States. 3. Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States. 4. Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Abstract
BACKGROUND: FIB-4, a non-invasive serum fibrosis index (which includes age, ALT, AST, and platelet count), is frequently available during ED visits. Our objective was to define 1-year HCV-related care outcomes of ED patients with known HCV, for the overall group, and both those with and without advanced fibrosis. METHODS: As part of an ongoing HCV linkage-to-care (LTC) program, HCV-infected ED patients were identified retrospectively via medical record review. Components of FIB-4 were abstracted, and patients with an FIB-4 > 3.25 were classified with advanced fibrosis and characterized with regards to downstream HCV care continuum outcomes at one-year after enrollment. RESULTS: Of the 113 patients with known HCV, 38 (33.6%) had advanced fibrosis. One-year outcomes along the HCV care continuum after ED encounter for 'all' 113, 75 'without advanced fibrosis', and 38 'advanced fibrosis' patients, respectively, were as follows: agreeing to be linked to care [106 (93.8%), 72 (96.0%), 34 (89.5%)]; LTC [38 (33.6%), 21 (28.0%), 17 (44.7%)]; treatment initiation among those linked [16 (42.1%), 9 (42.9%), 7 (41.2%)]; sustained virologic response 4 weeks post-treatment among those treated [15 (93.8%), 9 (100.0%), 6 (85.7%)]; documented all-cause mortality [10 (8.8%), 3 (4.0%), 7 (18.4%)]. Notably, 70% of those who died had advanced fibrosis. For those with advanced liver fibrosis, all-cause mortality was significantly higher, than those without (18.4% versus 4.0%, p = 0.030). CONCLUSIONS: Over one-third of HCV-infected ED patients have advanced liver fibrosis, incomplete LTC, and higher mortality, suggesting this readily-available FIB-4 might be used to prioritize LTC services for those with advanced fibrosis.
BACKGROUND: FIB-4, a non-invasive serum fibrosis index (which includes age, ALT, AST, and platelet count), is frequently available during ED visits. Our objective was to define 1-year HCV-related care outcomes of ED patients with known HCV, for the overall group, and both those with and without advanced fibrosis. METHODS: As part of an ongoing HCV linkage-to-care (LTC) program, HCV-infected EDpatients were identified retrospectively via medical record review. Components of FIB-4 were abstracted, and patients with an FIB-4 > 3.25 were classified with advanced fibrosis and characterized with regards to downstream HCV care continuum outcomes at one-year after enrollment. RESULTS: Of the 113 patients with known HCV, 38 (33.6%) had advanced fibrosis. One-year outcomes along the HCV care continuum after ED encounter for 'all' 113, 75 'without advanced fibrosis', and 38 'advanced fibrosis'patients, respectively, were as follows: agreeing to be linked to care [106 (93.8%), 72 (96.0%), 34 (89.5%)]; LTC [38 (33.6%), 21 (28.0%), 17 (44.7%)]; treatment initiation among those linked [16 (42.1%), 9 (42.9%), 7 (41.2%)]; sustained virologic response 4 weeks post-treatment among those treated [15 (93.8%), 9 (100.0%), 6 (85.7%)]; documented all-cause mortality [10 (8.8%), 3 (4.0%), 7 (18.4%)]. Notably, 70% of those who died had advanced fibrosis. For those with advanced liver fibrosis, all-cause mortality was significantly higher, than those without (18.4% versus 4.0%, p = 0.030). CONCLUSIONS: Over one-third of HCV-infected EDpatients have advanced liver fibrosis, incomplete LTC, and higher mortality, suggesting this readily-available FIB-4 might be used to prioritize LTC services for those with advanced fibrosis.
Authors: Eric M Yoshida; Mark S Sulkowski; Edward J Gane; Robert W Herring; Vlad Ratziu; Xiao Ding; Jing Wang; Shu-Min Chuang; Julie Ma; John McNally; Luisa M Stamm; Diana M Brainard; William T Symonds; John G McHutchison; Kimberly L Beavers; Ira M Jacobson; K Rajender Reddy; Eric Lawitz Journal: Hepatology Date: 2014-11-24 Impact factor: 17.425
Authors: Scott D Holmberg; Mei Lu; Loralee B Rupp; Lois E Lamerato; Anne C Moorman; Vinutha Vijayadeva; Joseph A Boscarino; Emily M Henkle; Stuart C Gordon Journal: Clin Infect Dis Date: 2013-04-16 Impact factor: 9.079
Authors: James W Galbraith; John P Donnelly; Ricardo A Franco; Edgar T Overton; Joel B Rodgers; Henry E Wang Journal: Clin Infect Dis Date: 2014-06-09 Impact factor: 9.079
Authors: Maxine M Denniston; Ruth B Jiles; Jan Drobeniuc; R Monina Klevens; John W Ward; Geraldine M McQuillan; Scott D Holmberg Journal: Ann Intern Med Date: 2014-03-04 Impact factor: 25.391
Authors: Javier A Cepeda; Sunil S Solomon; Aylur K Srikrishnan; Paneerselvam Nandagopal; Pachamuthu Balakrishnan; Muniratnam S Kumar; David L Thomas; Mark S Sulkowski; Shruti H Mehta Journal: Open Forum Infect Dis Date: 2016-07-23 Impact factor: 3.835
Authors: Ethel D Weld; Jacqueline Astemborski; Gregory D Kirk; Mark S Sulkowski; Stephanie Katz; Richard Rothman; Sunil S Solomon; Gail V Matthews; Yu Hsiang Hsieh; Malvika Verma; Giovanni Traverso; Susan Swindells; Andrew Owen; Jordan Feld; Charles Flexner; Shruti H Mehta; David L Thomas Journal: Clin Infect Dis Date: 2022-08-24 Impact factor: 20.999