Factors Associated With Delay of Diagnosis of Hepatocellular Carcinoma in Patients With Cirrhosis.
Factors Associated With Delay of Diagnosis of Hepatocellular Carcinoma in Patients With Cirrhosis.
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肝硬化患者肝细胞癌诊断延迟的相关因素。
DOI：
10.1016/j.cgh.2020.07.026
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Sada YH
中科院分区：
文献类型：
--
作者：
Choi DT;Davila JA;Sansgiry S;David E;Singh H;El-Serag HB;Sada YH
我们在退伍军人健康管理局的一组肝硬化患者中检查了肝细胞癌（HCC）诊断延迟的频率和相关因素。在一项回顾性研究中，我们收集和分析了退伍军人健康管理局电子健康记录的数据。我们使用多变量logistic回归模型来确定与红旗后超过60天的HCC诊断延迟相关的因素（根据美国肝病研究协会2005年指南，定义为HCC诊断的最早日期）。我们使用多变量考克斯比例风险模型来评估延迟诊断对生存率的影响，调整患者和供应商的特征。在2006年至2011年诊断为肝硬化和HCC的655例患者中，46.9%的患者在HCC红旗后延迟诊断超过60天。诊断延迟超过60天与提供者缺乏对指南的遵守显著相关（校正比值比[OR]，4.82; 95% CI，3.12-7.45），诊断性影像学评价，而不是仅测量甲胎蛋白（校正OR，2.63; 95%CI，1.09-6.24），诊断为检查期间的偶然发现，不相关的医学问题（与HCC相关评估相比）（调整后OR，2.26; 95%CI，1.09-4.67）。与未延迟诊断的患者相比，诊断延迟60天或更长时间与较低的死亡率相关（未校正的风险比，0.57; 95%CI，0.47-0.68和校正的风险比，0.63; 95%CI，0.50-0.78）。根据指南的定义，近一半的肝硬化退伍军人在红旗后延迟60天或更长时间诊断HCC。需要采取干预措施，以改善对HCC危险信号的及时随访和对指南的遵守，以增加HCC的早期发现。
We examined the frequency of and factors associated with delays in diagnosis of hepatocellular carcinoma (HCC) in a cohort of patients with cirrhosis in the Veterans Health Administration. In a retrospective study, we collected and analyzed data from the Veterans Health Administration’s electronic health records. We used a multivariate logistic regression model to identify factors associated with a delay in diagnosis of HCC of more than 60 days following a red flag (defined as the earliest date at which a diagnosis of HCC could have been made, based on American Association for the Study of Liver Disease 2005 guidelines). We used multivariate Cox proportional hazards model to evaluate the effects of delayed diagnosis on survival, adjusting for patient and provider characteristics. Among 655 patients with cirrhosis and a diagnosis of HCC from 2006 through 2011, 46.9% had a delay in diagnosis of more than 60 days following a red flag for HCC. Delays in diagnosis for more than 60 days were significantly associated with lack of provider adherence to the guidelines (adjusted odds ratio [OR], 4.82; 95% CI, 3.12–7.45), a diagnostic imaging evaluation instead of only measurement of alfa fetoprotein (adjusted OR, 2.63; 95% CI, 1.09–6.24), and diagnosis as an incidental finding during examination for an unrelated medical problem (compared with an HCC-related assessment) (adjusted OR, 2.26; 95% CI, 1.09–4.67). Diagnostic delays of 60 days or more were associated with lower mortality compared to patients without a delay in diagnosis (unadjusted hazard ratio, 0.57; 95% CI, 0.47–0.68 and adjusted hazard ratio, 0.63; 95% CI, 0.50–0.78). Nearly half of veterans with cirrhosis have delays in diagnosis of HCC of 60 days or more after a red flag, defined by guidelines. Interventions are needed to improve timely follow-up of red flags for HCC and adherence to guidelines, to increase early detection of HCC.
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DOI：
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发表时间：
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期刊：
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