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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 li...
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| Published in: | Digestive diseases and sciences 2024-10, Vol.69 (10), p.3721-3728 |
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| container_issue | 10 |
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| container_title | Digestive diseases and sciences |
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| creator | Patel, Kush M. Zhang, Jingwen Marsden, Justin Bays, Chloe Mauldin, Patrick D. Schreiner, Andrew D. |
| description | 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
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| doi_str_mv | 10.1007/s10620-024-08601-8 |
| format | article |
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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.</description><identifier>ISSN: 0163-2116</identifier><identifier>ISSN: 1573-2568</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-024-08601-8</identifier><identifier>PMID: 39304565</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Biochemistry ; Gastroenterology ; Hepatology ; Liver cancer ; Liver cirrhosis ; Liver diseases ; Medicine ; Medicine & Public Health ; Oncology ; Original Article ; Primary care ; Transplant Surgery</subject><ispartof>Digestive diseases and sciences, 2024-10, Vol.69 (10), p.3721-3728</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-80ab11f62a354db46cb7e43017826177f475cb220f690cdb845a7ca731f851993</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39304565$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patel, Kush M.</creatorcontrib><creatorcontrib>Zhang, Jingwen</creatorcontrib><creatorcontrib>Marsden, Justin</creatorcontrib><creatorcontrib>Bays, Chloe</creatorcontrib><creatorcontrib>Mauldin, Patrick D.</creatorcontrib><creatorcontrib>Schreiner, Andrew D.</creatorcontrib><title>Missed and Delayed Diagnoses of Chronic Liver Disease in Primary Care Patients with Cirrhosis</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><addtitle>Dig Dis Sci</addtitle><description>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.</description><subject>Biochemistry</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Liver cancer</subject><subject>Liver cirrhosis</subject><subject>Liver diseases</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Primary care</subject><subject>Transplant Surgery</subject><issn>0163-2116</issn><issn>1573-2568</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kE9P3DAQxa0KVBbaL8ABWeLCJTBjx39yrAKUSovKoT1WlpM4rNFuAp5sEd8et6Eg9cBpRprfezPzGDtEOEUAc0YIWkABoizAasDCfmALVEYWQmm7wxaAOveIeo_tE90BQGVQf2R7spJQKq0W7Nd1JAod90PHz8PaP-X-PPrbYaRAfOx5vUrjEFu-jL9DyiMKngKPA79JcePTE699CvzGTzEME_HHOK14HVNajRTpE9vt_ZrC55d6wH5eXvyor4rl96_f6i_Los2XToUF3yD2Wnipyq4pdduYUEpAY4VGY_rSqLYRAnpdQds1tlTetN5I7K3CqpIH7GT2vU_jwzbQ5DaR2rBe-yGMW3ISwSjIYp3R4__Qu3GbhnxdptCiKEUlMiVmqk0jUQq9u5_fdQjuT_huDt_l8N3f8J3NoqMX622zCd2r5F_aGZAzQHk03Ib0tvsd22c9ko0v</recordid><startdate>20241001</startdate><enddate>20241001</enddate><creator>Patel, Kush M.</creator><creator>Zhang, Jingwen</creator><creator>Marsden, Justin</creator><creator>Bays, Chloe</creator><creator>Mauldin, Patrick D.</creator><creator>Schreiner, Andrew D.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20241001</creationdate><title>Missed and Delayed Diagnoses of Chronic Liver Disease in Primary Care Patients with Cirrhosis</title><author>Patel, Kush M. ; Zhang, Jingwen ; Marsden, Justin ; Bays, Chloe ; Mauldin, Patrick D. ; Schreiner, Andrew D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-80ab11f62a354db46cb7e43017826177f475cb220f690cdb845a7ca731f851993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Biochemistry</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Liver cancer</topic><topic>Liver cirrhosis</topic><topic>Liver diseases</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Primary care</topic><topic>Transplant Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patel, Kush M.</creatorcontrib><creatorcontrib>Zhang, Jingwen</creatorcontrib><creatorcontrib>Marsden, Justin</creatorcontrib><creatorcontrib>Bays, Chloe</creatorcontrib><creatorcontrib>Mauldin, Patrick D.</creatorcontrib><creatorcontrib>Schreiner, Andrew D.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patel, Kush M.</au><au>Zhang, Jingwen</au><au>Marsden, Justin</au><au>Bays, Chloe</au><au>Mauldin, Patrick D.</au><au>Schreiner, Andrew D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Missed and Delayed Diagnoses of Chronic Liver Disease in Primary Care Patients with Cirrhosis</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><addtitle>Dig Dis Sci</addtitle><date>2024-10-01</date><risdate>2024</risdate><volume>69</volume><issue>10</issue><spage>3721</spage><epage>3728</epage><pages>3721-3728</pages><issn>0163-2116</issn><issn>1573-2568</issn><eissn>1573-2568</eissn><abstract>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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>39304565</pmid><doi>10.1007/s10620-024-08601-8</doi><tpages>8</tpages></addata></record> |
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| subjects | Biochemistry Gastroenterology Hepatology Liver cancer Liver cirrhosis Liver diseases Medicine Medicine & Public Health Oncology Original Article Primary care Transplant Surgery |
| title | Missed and Delayed Diagnoses of Chronic Liver Disease in Primary Care Patients with Cirrhosis |
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