Marked heterogeneity in the diagnosis of compensated cirrhosis of patients with chronic hepatitis C virus infection in a real-world setting: A large, multicenter study from Japan
Marked heterogeneity in the diagnosis of compensated cirrhosis of patients with chronic hepatitis C virus infection in a real-world setting: A large, multicenter study from Japan
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现实世界中慢性丙型肝炎病毒感染患者代偿性肝硬化的诊断存在显着异质性：来自日本的一项大型多中心研究
DOI：
10.1111/jgh.14982
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发表时间：
2020
期刊：
影响因子：
--
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et al
中科院分区：
文献类型：
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作者：
Toyoda H;Atsukawa M;Watanabe T...;Tsubota A;et al
背景和目的肝硬化的存在是丙型肝炎病毒（HCV）感染患者管理的重要因素，它决定了使用直接作用抗病毒（DAA）方案（GLE）和pibentasvir（PIB）治疗HCV的持续时间，即8或12周，如果患者没有DAA失败史。然而，在真实的环境中，肝硬化的确定取决于主治肝病学家的判断，目前还不清楚代偿性肝硬化是否被同质诊断。在这项研究中，我们通过描述接受12周GLE/PIB方案的DAA初治患者（其中诊断为肝硬化），将其特征与接受8周方案的无肝硬化患者的特征进行比较，研究了肝硬化的真实的诊断。我们比较了接受8周与12周GLE/PIB方案的DAA初治患者的背景特征和治疗结果。296例（30.3%）被确定为肝硬化，并接受了12周的治疗方案。两组患者的一些特征在很大程度上重叠，包括肝纤维化指标。调整肝纤维化指数与倾向评分matching.ConclusionAlthough充分诊断，肝硬化的确定有很大的不同机构或肝病学家在真实的-世界设置，肝纤维化的严重程度重叠的患者中，代偿性肝硬化被确定为存在和肝硬化的患者中，没有。调整肝纤维化程度后，病毒学疗效相似。
Background and AimThe presence of cirrhosis is an important factor for the management of patients with hepatitis C virus (HCV) infection and it determines the duration of treatment for HCV with the direct‐acting antiviral (DAA) regimen of glecaprevir (GLE) and pibrentasvir (PIB), that is, 8 or 12 weeks, if patients do not have a history of DAA failure. However, in real‐world settings, determination of cirrhosis depends on the discretion of the attending hepatologists, and it is unclear whether compensated cirrhosis was homogenously diagnosed or not. In this study, we investigated the real‐world diagnosis of cirrhosis by characterizing DAA‐naïve patients who underwent a 12‐week GLE/PIB regimen in whom cirrhosis was diagnosed, comparing their characteristics with those of patients who underwent an 8‐week regimen in whom cirrhosis was absent.MethodsIn a large, multicenter cohort study, we compared background characteristics and treatment outcomes among DAA‐naïve patients who underwent an 8‐week versus a 12‐week GLE/PIB regimen.ResultsAmong 977 patients enrolled, 296 (30.3%) were determined to have cirrhosis and underwent a 12‐week regimen. Some patient characteristics largely overlapped between the two groups, including liver fibrosis indices. Sustained viral response rates were similar between groups after adjusting liver fibrosis index with propensity score matching.ConclusionAlthough adequately diagnosed, the determination of cirrhosis varied widely among institutions or by hepatologists in real‐world settings, and the severity of liver fibrosis overlapped significantly between patients in whom compensated cirrhosis was determined to be present and patients in whom cirrhosis was absent. Virologic efficacy was similar after adjusting for the degree of liver fibrosis.