Missed and Delayed Diagnoses of Chronic Liver Disease in Primary Care Patients with Cirrhosis

• Published in: Digestive diseases and sciences 2024-10, Vol.69 (10), p.3721-3728
• Main Authors: Patel, Kush M., Zhang, Jingwen, Marsden, Justin, Bays, Chloe, Mauldin, Patrick D., Schreiner, Andrew D.
• Format: Article
• Language: English
• Subjects: Biochemistry; Gastroenterology; Hepatology; Liver cancer; Liver cirrhosis; Liver diseases; Medicine; Medicine & Public Health; Oncology; Original Article; Primary care; Transplant Surgery
• ISSN: 0163-2116; 1573-2568; 1573-2568
• DOI: 10.1007/s10620-024-08601-8

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