title: Prevalence of cirrhosis in hepatitis C patients in the Chronic Hepatitis Cohort Study (CHeCS): a retrospective and prospective observational study.
abstract: OBJECTIVE
  The severity of liver disease in the hepatitis C virus (HCV)-infected population in the United States remains uncertain. We estimated the prevalence of cirrhosis in adults with chronic hepatitis C (CHC) using multiple parameters including liver biopsy, diagnosis/procedure codes, and a biomarker.
  
  
  METHODS
  Patients enrolled in the Chronic Hepatitis Cohort Study (CHeCS) who received health services during 2006-2010 were included. Cirrhosis was identified through liver biopsy reports, diagnosis/procedure codes for cirrhosis or hepatic decompensation, and Fibrosis-4 (FIB-4) scores ≥5.88. Demographic and clinical characteristics associated with cirrhosis were identified through multivariable logistic modeling.
  
  
  RESULTS
  Among 9,783 patients, 2,788 (28.5%) were cirrhotic by at least one method. Biopsy identified cirrhosis in only 661 (7%) patients, whereas FIB-4 scores and diagnosis/procedure codes for cirrhosis and hepatic decompensation identified cirrhosis in 2,194 (22%), 557 (6%), and 482 (5%) patients, respectively. Among 661 patients with biopsy-confirmed cirrhosis, only 356 (54%) had an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for cirrhosis. Older age, male gender, Asian race, Hispanic ethnicity, genotype 3 infection, HIV coinfection, diabetes, history of antiviral therapy, and history of alcohol abuse were independently associated with higher odds of cirrhosis (all, P<0.05). Conversely, private health insurance coverage, black race, and HCV genotype 2 were associated with lower odds of cirrhosis.
  
  
  CONCLUSIONS
  A high proportion of patients with biopsy-confirmed cirrhosis are not assigned ICD-9 codes for cirrhosis. Consequently, ICD-9 codes may not be reliable as the sole indicator of the prevalence of cirrhosis in cohort studies. Use of additional parameters suggests a fourfold higher prevalence of cirrhosis than is revealed by biopsy alone. These findings suggest that cirrhosis in CHC patients may be significantly underdocumented and underdiagnosed.
authors.affiliation: Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Gordon
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Lois E
authors.initials: LE
authors.lastname: Lamerato
authors.affiliation: Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Loralee B
authors.initials: LB
authors.lastname: Rupp
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Holmberg
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Moorman
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Spradling
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Eyasu
authors.initials: E
authors.lastname: Teshale
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Fujie
authors.initials: F
authors.lastname: Xu
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Boscarino
authors.affiliation: Center for Health Research, Kaiser Permanente-Hawaii, Honolulu, Hawaii, USA.
authors.forename: Vinutha
authors.initials: V
authors.lastname: Vijayadeva
authors.affiliation: Center For Health Research, Kaiser Permanente-Northwest, Portland, Oregon, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schmidt
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Oja-Tebbe
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001213:Asian / Q000706:statistics & numerical data; D001706:Biopsy; D060085:Coinfection; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D038801:International Classification of Diseases; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents