Cirrhosis Underestimated in Hepatitis C Patients

Hepatitis C patients’ liver damage may be severely underestimated and under diagnosed, according to a recently published study in The American Journal of Gastroenterology.

To estimate the cirrhosis prevalence in adults, researchers from the Henry Ford Health System in Detroit evaluated patients enrolled in the Chronic Hepatitis Cohort Study who received health services between 2006 and 2010.

The researchers used a variety of parameters including liver biopsy, diagnosis and procedure codes, and a biomarker to evaluate the liver damage. There were nearly 10,000 hepatitis C patients from four US health systems included in the analysis.

“Knowledge of the prevalence of liver damage will help decision making regarding screening for the effects of hepatitis C, when to start antiviral therapy, and the need for follow up counseling,” Stuart Gordon, MD, lead researcher and Director of Hepatology at Henry Ford Hospital, explained in a press release.

Liver damage was present in 29% of the patients (approximately 3,000 patients) with hepatitis C, the researchers discovered. But of those patients suffering from cirrhosis, two thirds had no official documentation in their medical records indicating liver damage.

The researchers believe this statistic suggested under diagnosis and underestimation of liver damage in the hepatitis C infected patient population.

Using the FIB 4 score, a proven method used to calculate liver damage, the researchers were able to estimate the likely signs of the cirrhosis using the patients’ enzymes, platelet counts, and age.

“Our results suggest a fourfold higher prevalence of cirrhosis than is indicated by biopsy alone,” continued Gordon. “It’s an under appreciated, easily obtained and widely available test done through lab work that can point out there’s a problem. It’s a simple test not routinely used by clinicians. A lot of patients in our study had cirrhosis and probably didn’t know they had cirrhosis. In addition, electronic medical record reports may not be a reliable indicator of just how many hepatitis C patients may be suffering from cirrhosis.”

The researchers believe their results could impact the treatment for hepatitis C patients with cirrhosis. Today, they are curable diseases with different oral antiviral treatments.

“Sometimes the clues of liver damage or cirrhosis are very subtle — a dropping platelet count, a spleen size that is slightly increased on an ultrasound,” concluded Gordon. “It is not unusual for patients with hepatitis C to come in and they have liver cancer, and they didn’t even know that they had cirrhosis that led to their cancer. People with hepatitis C need to find out the severity of their underlying liver disease, because they may not realize that they have cirrhosis. Obviously, treatment can slow down the progression.”