Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: The DOPPS
Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: The DOPPS
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DOI：
10.1111/j.1523-1755.2004.00649.x
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发表时间：
2004-06-01
影响因子：
19.6
通讯作者：
Young, EW
中科院分区：
文献类型：
--
作者：
Fissell, RB;Bragg-Gresham, JL;Young, EW
背景丙型肝炎病毒（HCV）仍然是血液透析单位的一个问题。本研究测量了7个国家的HCV流行率和血清转换率，并调查了与设施水平实践模式的关联。研究样本来自透析结局和实践模式研究（DOPPS），这是一项前瞻性、观察性研究，研究对象为从法国、德国、意大利、日本、西班牙、英国和美国的308家代表性透析机构中随机选择的成人血液透析患者。Logistic回归用于模拟HCV患病率的比值，考克斯回归用于模拟从研究进入到HCV血清转换的时间。平均HCV设施患病率为13.5%，不同国家从2.6%到22.9%不等。HCV感染率增加与透析时间延长、男性、黑人、糖尿病、肾移植前感染B型肝炎（HBV）以及过去12个月内酗酒或滥用药物有关。大约一半的设施（55.6%）在研究期间没有血清转化。HCV血清转换与透析时间延长、人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）、HBV感染和复发性蜂窝织炎或坏疽相关。训练有素的工作人员的增加与较低的HCV流行率（OR=0.93每10%的增加，P=0.003）和血清转换的风险（RR=0.92，P=0.07）。血清转换与设施HCV感染率的增加相关（RR=1.36，P
Background. Hepatitis C virus (HCV) remains a problem within hemodialysis units. This study measures HCV prevalence and seroconversion rates across seven countries and investigates associations with facility-level practice patterns.Methods. The study sample was from the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective, observational study of adult hemodialysis patients randomly selected from 308 representative dialysis facilities in France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States. Logistic regression was used to model odds of HCV prevalence, and Cox regression was used to model time from study entry to HCV seroconversion.Results. Mean HCV facility prevalence was 13.5% and varied among countries from 2.6% to 22.9%. Increased HCV prevalence was associated with longer time on dialysis, male gender, black race, diabetes, hepatitis B (HBV) infection prior renal transplant, and alcohol or substance abuse in the previous 12 months. Approximately half of the facilities (55.6%) had no seroconversions during the study period. HCV seroconversion was associated with longer time on dialysis, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), HBV infection, and recurrent cellulitis or gangrene. An increase in highly trained staff was associated with lower HCV prevalence (OR=0.93 per 10% increase, P=0.003) and risk of seroconversion (RR=0.92, P=0.07). Seroconversion was associated with an increase in facility HCV prevalence (RR=1.36, P