Prevalence and associated factors of viral hepatitis and transferrin elevations in 5036 patients admitted to the emergency room of a Swiss university hospital: cross-sectional study.
BACKGROUND
The epidemiology of liver disease in patients admitted to emergency rooms is largely unknown. The current study aimed to measure the prevalence of viral hepatitis B and C infection and pathological laboratory values of liver disease in such a population, and to study factors associated with these measurements.


METHODS
Cross-sectional study in patients admitted to the emergency room of a university hospital. No formal exclusion criteria. Determination of anti-HBs, anti-HCV, transferrin saturation, alanine aminotransferase, and obtaining answers from a study-specific questionnaire.


RESULTS
The study included 5'036 patients, representing a 14.9% sample of the target population during the study period. Prevalence of anti-HBc and anti-HCV was 6.7% (95%CI 6.0% to 7.4%) and 2.7% (2.3% to 3.2%), respectively. Factors independently associated with positive anti-HBc were intravenous drug abuse (OR 18.3; 11.3 to 29.7), foreign country of birth (3.4; 2.6 to 4.4), non-white ethnicity (2.7; 1.9 to 3.8) and age > or =60 (2.0; 1.5 to 2.8). Positive anti-HCV was associated with intravenous drug abuse (78.9; 43.4 to 143.6), blood transfusion (1.7; 1.1 to 2.8) and abdominal pain (2.7; 1.5 to 4.8). 75% of all participants were not vaccinated against hepatitis B or did not know their vaccination status. Among anti-HCV positive patients only 49% knew about their infection and 51% reported regular alcohol consumption. Transferrin saturation was elevated in 3.3% and was associated with fatigue (prevalence ratio 1.9; 1.2 to 2.8).


CONCLUSIONS
Emergency rooms should be considered as targets for public health programs that encourage vaccination, patient education and screening of high-risk patients for liver disease with subsequent referral for treatment if indicated.
Russmann
Stefan
S
Department of Clinical Pharmacology, University of Berne, Berne, Switzerland. russmann@bu.edu
Dowlatshahi
Emmilia A
EA
Printzen
Gert
G
Habicht
Susanne
S
Reichen
Jürg
J
Zimmermann
Heinz
H
D000328:Adult; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000453:epidemiology*; D006510:Hepatitis B Antibodies / Q000097:blood; D006526:Hepatitis C / Q000097:blood / Q000453:epidemiology*; D018937:Hepatitis C Antibodies / Q000097:blood; D006785:Hospitals, University; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013557:Switzerland; D014168:Transferrin / Q000378:metabolism*
D006510:Hepatitis B Antibodies; D018937:Hepatitis C Antibodies; D014168:Transferrin