ABSTRACT
Introduction and Objectives: Strategies to simplify the care circuit for patients with the hepatitis C virus (HCV) are vital to achieving its eradication. To achieve this aim, we introduced an electronic system of HCV serology detection to link diagnosis with specialized assistance in order to minimize the loss of patients. Material(s) and Method(s): A retrospective single-center study of HCV patients developed by Microbiology Department from February 15th, 2020, to December 15th, 2021. In the event of a positive HCV antibody, the anti-HCV core was directly measured by the electronic system. If positive, an encrypted e-mail with the patient data was automatically sent to HCV specialized physicians, who, after evaluating the benefits of antiviral therapy in each patient, contacted them by phone for an appointment. In the first face-to-face consultation FibroScan, HCV genotype and viral load measurement were performed, and antiviral therapy was prescribed. Patient diagnosis origin and public health characteristics were recorded. We analyzed the association between antiviral therapy prescription and these variables. Statistical significance was set at p<0.005. Result(s): Of 171 patients identified, with a mean age of 59.6 +/- 15.9, 61.5 % of males and 81.2% of Spanish nationals. HCV origin from out-of-hospital settings predominated (50.9%, 87/171), particularly primary care (28.7%), penitentiary (11.6%) and addiction units (8.2%). In all, 43.3% (74/171) were aware of their diagnosis, but 64.9% (48/74) hadn't previously received antiviral therapy. Genotype 1 predominated. We recorded 19.4% (20/103) of patients F3 fibrosis and 27.2% (26/103) F4. Finally, 58.5% (100/171) attended a physician consultation. They were all treated with pangenotypic interferon-free therapy. A 100% rate of sustained viral response was achieved. The main reasons for not being treated were high comorbidity (43.7%,31/71), not located (23.9%, 17/71), patient refusal to treatment (23.9%,17/71) and death (8.5%,6/71). The sole association found between antiviral therapy and patient variables was that of comorbidities with being untreated (OR=7.14, p<0.001). Conclusion(s): Our alert system is simple and easily reproducible. It allows for minimizing the loss of HCV patients, even considering it was performed during the COVID-19 pandemic.Copyright © 2023
ABSTRACT
Background: COVID-19 is commonly manifested with respiratory pathology, but has also been reported to cause liver damage Our aim is to assess in admitted patients with COVID-19 whether liver damage is associated with a worse prognosis and if there are differences between the moment of the onset of liver damage (at or during admission) Methods: We use an unicentric retrospective study with adult patients admitted with COVID-19 (PCR diagnosis) Patients with previous liver disease or damage and those with suspected drug hepatotoxicity were excluded 303 patients were registered and their baseline characteristics were determined: age, sex and chronic diseases (cardiovascular risk factors, pneumological and cardiological diseases and chronic renal impairment). Liver damage was defined as ALT, AST, bilirubin, ALP or GGT elevation over our laboratory ranges COVID-19 moderate stage is considered if advanced interstitial radiological pattern or pneumonia is presented and severe stage if it associates tachypnea, hypoxia or respiratory failure. Deterioration is defined as a more serious stage progression and improvement as a change to a less serious stage Statistical analysis was performed by age-adjusted binary logistic regression. The significance level (p-value) was 5% (α=0'05). Results: Males predominate (51'3%) with an average age of 69'3 years old The overall prevalence of liver damage was 60 9%, with 46 4% liver damage at admission and the remaining 14 5% during admission (74 8% for the first 8 days). At admission 52.7% had moderate stage and 34 1% severe Subgroups with and without liver damage had no significant differences in baseline characteristics. Significant association between liver damage was observed at moderate and severe stages (p 0'011 and p 0'031) During admission 66 2% improved the initial stage, but 13 2% deteriorated (moderate to severe) 14 9% required admission to ICU and 21 9% died At admission it was observed that patients with liver damage had a higher risk of deterioration (p 0'001) and a lower probability of improvement (p 0'001) If liver damage occurs during admission there is still a higher risk of deterioration (p 0'002);however, there is a tendency without statistical significance, regarding the likelihood of non improvement (p 0'055) Conclusion: The liver damage prevalence in our study in admitted COVID-19 patients is high and is related to greater severity and less favorable evolution, whether it appears at or during admission Therefore, it is important to monitor liver function parameters.