基层医疗机构肝硬化患者慢性肝病的漏诊和延误诊断。

IF 2.5 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Digestive Diseases and Sciences Pub Date : 2024-10-01 Epub Date: 2024-09-20 DOI:10.1007/s10620-024-08601-8
Kush M Patel, Jingwen Zhang, Justin Marsden, Chloe Bays, Patrick D Mauldin, Andrew D Schreiner
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引用次数: 0

摘要

背景:慢性肝病(CLD)、肝硬化和肝细胞癌(HCC)会导致严重的发病率和死亡率。遗憾的是,慢性肝病患者在发展为肝硬化和肝细胞癌之前往往得不到诊断。我们旨在确定有严重肝病结果的初级保健患者中漏诊或延迟诊断 CLD 的比例:这项回顾性队列研究对 2012 年至 2021 年期间诊断出肝硬化、HCC 或其他严重肝病结果的初级保健患者进行了评估。研究对象为漏诊和延迟诊断的慢性肝病患者,漏诊和延迟诊断的定义为未诊断出慢性肝病(漏诊)或在诊断出肝硬化的同一天首次出现慢性肝病(延迟诊断)。对队列进行了单变量分析。多变量逻辑回归模型分析了转氨酶升高与相关结果的关系:在667名肝硬化或肝癌患者中,133人(20%)被漏诊为CLD,243人(36%)被延迟诊断为CLD。在漏诊/延迟诊断的患者中,酒精相关肝病是最常见的病因。与及时诊断的患者相比,漏诊/延迟诊断的患者中出现谷丙转氨酶(ALT)或谷草转氨酶(AST)升高的比例较低(61% 对 77%,P):大多数肝硬化或 HCC 患者的 CLD 诊断被漏诊或延迟,这可能是由于过度依赖转氨酶升高来检测 CLD。需要在初级保健中加强对高发 CLD(尤其是酒精中毒)的筛查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Missed and Delayed Diagnoses of Chronic Liver Disease in Primary Care Patients with Cirrhosis.

Background: Chronic liver diseases (CLD), cirrhosis, and hepatocellular carcinoma (HCC) cause significant morbidity and mortality. Unfortunately, patients with CLD often go undiagnosed until progression to cirrhosis and HCC. We aimed to determine the proportion of primary care patients with severe liver disease outcomes that had missed or delayed CLD diagnoses.

Methods: This retrospective cohort study evaluated primary care patients with a diagnosis of cirrhosis, HCC, or other severe liver disease outcome between 2012 and 2021. The outcomes of interest were missed and delayed diagnoses of CLD, defined as the absence of a CLD diagnosis (missed) or first appearance of CLD on the same day as the cirrhosis diagnosis (delayed). Univariate analyses were performed to describe the cohort. Multivariable logistic regression models analyzed the association of aminotransferase elevations with the outcomes of interest.

Results: Of 667 patients with cirrhosis or HCC, 133 (20%) had a missed CLD diagnosis, and 243 (36%) had a delayed CLD diagnosis. Alcohol-related liver disease was the most common etiology among patients with missed/delayed diagnoses. A lower proportion of patients with missed/delayed diagnoses had an elevation in ALT or AST compared to patients with timely diagnoses (61% vs. 77%, p < 0.001). Elevated aminotransferase values were associated with lower odds of a missed/delayed diagnosis (OR 0.47; 95%CI 0.34-0.66).

Conclusions: Most patients with cirrhosis or HCC had missed or delayed diagnoses of CLD in the context of probable overreliance on aminotransferase elevation for CLD detection. Enhanced screening for high prevalence CLD, especially alcohol, in primary care is needed.

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来源期刊
Digestive Diseases and Sciences
Digestive Diseases and Sciences 医学-胃肠肝病学
CiteScore
6.40
自引率
3.20%
发文量
420
审稿时长
1 months
期刊介绍: Digestive Diseases and Sciences publishes high-quality, peer-reviewed, original papers addressing aspects of basic/translational and clinical research in gastroenterology, hepatology, and related fields. This well-illustrated journal features comprehensive coverage of basic pathophysiology, new technological advances, and clinical breakthroughs; insights from prominent academicians and practitioners concerning new scientific developments and practical medical issues; and discussions focusing on the latest changes in local and worldwide social, economic, and governmental policies that affect the delivery of care within the disciplines of gastroenterology and hepatology.
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